- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.87 / $1,393.81 / $1,476.20
| Facility | | $1,376.87 | $1,393.81 | $1,476.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.39 / $1,393.81 / $1,665.34
| Professional | | $1,353.39 | $1,393.81 | $1,665.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.81 / $1,543.30 / $1,543.30
| Professional | | $1,311.81 | $1,543.30 | $1,543.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.77 / $2,095.62 / $2,510.79
| Professional | | $1,996.77 | $2,095.62 | $2,510.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.87 / $1,393.81 / $1,476.20
| Facility | | $1,376.87 | $1,393.81 | $1,476.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.28 / $1,389.03 / $1,665.34
| Professional | | $1,339.28 | $1,389.03 | $1,665.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.67 / $1,342.67 / $1,342.67
| Professional | | $1,342.67 | $1,342.67 | $1,342.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.67 / $1,342.67 / $1,557.02
| Professional | | $1,342.67 | $1,342.67 | $1,557.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.77 / $2,095.62 / $2,510.79
| Professional | | $1,996.77 | $2,095.62 | $2,510.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.77 / $1,336.77 / $1,336.77
| Professional | | $1,336.77 | $1,336.77 | $1,336.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.67 / $1,342.67 / $1,342.67
| Professional | | $1,342.67 | $1,342.67 | $1,342.67 |