- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.03 / $1,918.86 / $3,576.22
| Facility | | $1,380.03 | $1,918.86 | $3,576.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,336.58 / $1,665.92
| Professional | | $1,323.35 | $1,336.58 | $1,665.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.35 / $2,098.57 / $4,351.27
| Facility | | $1,323.35 | $2,098.57 | $4,351.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,323.35
| Professional | | $1,323.35 | $1,323.35 | $1,323.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,323.35
| Facility | | $1,323.35 | $1,323.35 | $1,323.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.35 / $1,323.35 / $1,323.35
| Professional | | $1,323.35 | $1,323.35 | $1,323.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.28 / $1,373.28 / $1,687.19
| Professional | | $1,373.28 | $1,373.28 | $1,687.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.33 / $1,323.35 / $1,473.17
| Professional | | $1,260.33 | $1,323.35 | $1,473.17 |