- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.85 / $911.85 / $1,842.32
| Facility | | $911.85 | $911.85 | $1,842.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.78 / $915.20 / $989.53
| Professional | | $876.78 | $915.20 | $989.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,455.43 / $1,648.88 / $1,842.32
| Facility | | $1,455.43 | $1,648.88 | $1,842.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.74 / $1,002.36 / $1,353.18
| Professional | | $898.74 | $1,002.36 | $1,353.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.21 / $2,026.55 / $2,763.48
| Facility | | $1,389.21 | $2,026.55 | $2,763.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.97 / $2,026.55 / $2,487.13
| Professional | | $1,565.97 | $2,026.55 | $2,487.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.38 / $1,028.38 / $1,842.32
| Facility | | $1,028.38 | $1,028.38 | $1,842.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.72 / $750.72 / $1,889.86
| Professional | | $750.72 | $750.72 | $1,889.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.38 / $880.75 / $1,237.08
| Professional | | $547.38 | $880.75 | $1,237.08 |