- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.96 / $1,630.91 / $2,920.67
| Facility | | $1,086.96 | $1,630.91 | $2,920.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.96 / $1,086.96 / $1,086.96
| Professional | | $1,086.96 | $1,086.96 | $1,086.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.19 / $1,588.84 / $3,229.72
| Facility | | $1,076.19 | $1,588.84 | $3,229.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.15 / $1,045.15 / $1,045.15
| Professional | | $1,045.15 | $1,045.15 | $1,045.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.15 / $1,045.15 / $1,045.15
| Facility | | $1,045.15 | $1,045.15 | $1,045.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.15 / $1,045.15 / $1,045.15
| Professional | | $1,045.15 | $1,045.15 | $1,045.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.58 / $1,133.89 / $1,307.42
| Professional | | $1,084.58 | $1,133.89 | $1,307.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.64 / $1,045.15 / $1,457.28
| Professional | | $940.64 | $1,045.15 | $1,457.28 |