- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,220.28 / $1,220.28 / $2,465.48
| Facility | | $1,220.28 | $1,220.28 | $2,465.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.38 / $1,220.28 / $1,324.24
| Professional | | $1,097.38 | $1,220.28 | $1,324.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.73 / $2,206.60 / $2,465.48
| Facility | | $1,947.73 | $2,206.60 | $2,465.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.74 / $1,271.10 / $1,754.13
| Professional | | $1,202.74 | $1,271.10 | $1,754.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.50 / $2,655.15 / $3,451.67
| Facility | | $1,805.50 | $2,655.15 | $3,451.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.66 / $2,712.03 / $3,328.40
| Professional | | $2,095.66 | $2,712.03 | $3,328.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.28 / $1,327.28 / $2,465.48
| Facility | | $1,327.28 | $1,327.28 | $2,465.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.91 / $1,327.28 / $2,336.53
| Professional | | $968.91 | $1,327.28 | $2,336.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,398.59 / $3,398.59 / $3,398.59
| Facility | | $3,398.59 | $3,398.59 | $3,398.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.47 / $1,175.16 / $1,632.96
| Professional | | $706.47 | $1,175.16 | $1,632.96 |