- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.76 / $1,218.65 / $1,547.11
| Facility | | $1,194.76 | $1,218.65 | $1,547.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.90 / $1,252.56 / $1,777.51
| Professional | | $978.90 | $1,252.56 | $1,777.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,131.96 / $2,655.92 / $4,557.81
| Facility | | $2,131.96 | $2,655.92 | $4,557.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.67 / $1,275.38 / $1,912.51
| Professional | | $1,254.67 | $1,275.38 | $1,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.00 / $1,620.00 / $1,620.00
| Facility | | $1,620.00 | $1,620.00 | $1,620.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.59 / $1,620.00 / $1,668.60
| Professional | | $1,182.59 | $1,620.00 | $1,668.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,365.94 / $2,783.46 / $2,783.46
| Facility | | $2,365.94 | $2,783.46 | $2,783.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.00 / $1,188.30 / $1,673.44
| Professional | | $900.00 | $1,188.30 | $1,673.44 |