- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $2,630.27
| Facility | | $1,148.15 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $2,570.40
| Professional | | $1,148.15 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $5,754.40
| Facility | | $1,148.15 | $1,548.82 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,513.56 / $3,388.44
| Professional | | $1,479.11 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $12,589.25
| Facility | | $2,137.96 | $2,137.96 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $4,365.16
| Professional | | $1,548.82 | $1,548.82 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $3,388.44
| Facility | | $1,230.27 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,137.96
| Professional | | $1,047.13 | $1,412.54 | $2,137.96 |