- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,311.31
| Facility | | $1,621.81 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,162.28
| Professional | | $1,621.81 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,089.30 / $7,585.78
| Facility | | $1,548.82 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,041.74 / $4,466.84
| Professional | | $1,949.84 | $2,041.74 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $14,125.38
| Facility | | $2,691.53 | $2,691.53 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $5,495.41
| Professional | | $1,949.84 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,630.27 / $4,570.88
| Facility | | $1,819.70 | $2,630.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,884.03
| Professional | | $1,412.54 | $1,862.09 | $2,884.03 |