- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.75 / $1,737.10 / $9,450.64
| Facility | | $1,201.75 | $1,737.10 | $9,450.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,922.39
| Professional | | $1,730.32 | $1,730.32 | $1,922.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.41 / $2,058.41 / $2,058.41
| Professional | | $2,058.41 | $2,058.41 | $2,058.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,730.32
| Facility | | $1,730.32 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,730.32
| Professional | | $1,730.32 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.81 / $8,351.50 / $8,651.60
| Facility | | $2,221.81 | $8,351.50 | $8,651.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.30 / $1,670.30 / $2,037.77
| Facility | | $1,670.30 | $1,670.30 | $2,037.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,834.14 / $2,214.81
| Professional | | $1,730.32 | $1,834.14 | $2,214.81 |