- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.04 / $1,576.04 / $1,668.75
| Facility | | $1,576.04 | $1,576.04 | $1,668.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.13 / $1,513.44 / $1,988.58
| Professional | | $1,221.13 | $1,513.44 | $1,988.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.28 / $2,524.41 / $3,687.22
| Facility | | $2,450.28 | $2,524.41 | $3,687.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.95 / $1,965.62 / $2,098.57
| Professional | | $1,576.95 | $1,965.62 | $2,098.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.06 / $1,772.06 / $2,111.63
| Facility | | $1,772.06 | $1,772.06 | $2,111.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.25 / $1,772.06 / $2,720.83
| Professional | | $1,506.25 | $1,772.06 | $2,720.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.65 / $1,020.61 / $1,791.25
| Facility | | $120.65 | $1,020.61 | $1,791.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.05 / $1,310.18 / $2,087.85
| Professional | | $928.05 | $1,310.18 | $2,087.85 |