- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.96 / $3,109.61 / $4,810.25
| Facility | | $2,264.96 | $3,109.61 | $4,810.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,294.26 / $1,294.26 / $1,294.26
| Professional | | $1,294.26 | $1,294.26 | $1,294.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.13 / $1,456.13 / $1,820.16
| Professional | | $1,456.13 | $1,456.13 | $1,820.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.48 / $1,052.92 / $1,896.39
| Professional | | $920.48 | $1,052.92 | $1,896.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $718.96 / $2,033.28
| Facility | | $1.00 | $718.96 | $2,033.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.96 / $1,388.63 / $1,855.23
| Professional | | $692.96 | $1,388.63 | $1,855.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.00 / $725.00 / $2,033.28
| Facility | | $648.00 | $725.00 | $2,033.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.00 / $1,255.09 / $2,043.15
| Professional | | $648.00 | $1,255.09 | $2,043.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.63 / $1,388.63 / $1,416.40
| Professional | | $1,388.63 | $1,388.63 | $1,416.40 |