- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.14 / $1,189.14 / $1,426.97
| Facility | | $1,189.14 | $1,189.14 | $1,426.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.75 / $943.12 / $1,422.37
| Professional | | $922.75 | $943.12 | $1,422.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,111.91 / $2,111.91 / $2,503.46
| Facility | | $2,111.91 | $2,111.91 | $2,503.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.51 / $1,300.05 / $1,300.05
| Professional | | $1,233.51 | $1,300.05 | $1,300.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.83 / $1,207.83 / $1,207.83
| Facility | | $1,207.83 | $1,207.83 | $1,207.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.72 / $881.72 / $1,287.59
| Professional | | $881.72 | $881.72 | $1,287.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.92 / $1,709.92 / $5,277.67
| Professional | | $1,709.92 | $1,709.92 | $5,277.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.55 / $1,055.55 / $1,055.55
| Facility | | $1,055.55 | $1,055.55 | $1,055.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.40 / $1,053.60 / $1,486.00
| Professional | | $702.40 | $1,053.60 | $1,486.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.75 / $1,739.93 / $2,214.44
| Professional | | $1,581.75 | $1,739.93 | $2,214.44 |