- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.90 / $1,863.73 / $6,728.62
| Facility | | $1,862.90 | $1,863.73 | $6,728.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,862.90 / $2,189.42
| Professional | | $1,808.65 | $1,862.90 | $2,189.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,235.83 / $4,027.74 / $7,619.30
| Facility | | $2,235.83 | $4,027.74 | $7,619.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,750.63 / $1,842.77 / $1,842.77
| Professional | | $1,750.63 | $1,842.77 | $1,842.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.52 / $1,808.65 / $1,808.65
| Professional | | $1,088.52 | $1,808.65 | $1,808.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.65 / $2,712.98 / $5,814.84
| Facility | | $1,808.65 | $2,712.98 | $5,814.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,862.90 / $2,170.38
| Professional | | $1,808.65 | $1,862.90 | $2,170.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $2,025.69 / $2,170.38
| Professional | | $1,808.65 | $2,025.69 | $2,170.38 |