- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.81 / $1,081.81 / $1,081.81
| Facility | | $1,081.81 | $1,081.81 | $1,081.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.40 / $1,081.81 / $1,454.73
| Professional | | $917.40 | $1,081.81 | $1,454.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.80 / $2,170.57 / $3,940.87
| Facility | | $1,931.80 | $2,170.57 | $3,940.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.64 / $1,148.64 / $1,148.64
| Professional | | $1,148.64 | $1,148.64 | $1,148.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.09 / $1,207.09 / $1,207.09
| Facility | | $1,207.09 | $1,207.09 | $1,207.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.18 / $881.18 / $2,067.09
| Professional | | $881.18 | $881.18 | $2,067.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.17 / $1,081.81 / $2,414.75
| Facility | | $622.17 | $1,081.81 | $2,414.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.17 / $622.17 / $622.17
| Professional | | $622.17 | $622.17 | $622.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.21 / $2,414.75 / $3,824.96
| Professional | | $1,410.21 | $2,414.75 | $3,824.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.08 / $963.76 / $1,606.26
| Professional | | $875.08 | $963.76 | $1,606.26 |