- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.37 / $1,812.37 / $1,812.37
| Facility | | $1,812.37 | $1,812.37 | $1,812.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.51 / $1,812.37 / $2,136.21
| Professional | | $1,680.51 | $1,812.37 | $2,136.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.83 / $1,207.83 / $2,368.44
| Facility | | $1,207.83 | $1,207.83 | $2,368.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.38 / $2,508.38 / $3,135.47
| Professional | | $2,508.38 | $2,508.38 | $3,135.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.54 / $3,610.19 / $10,094.70
| Facility | | $1,609.54 | $3,610.19 | $10,094.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.47 / $1,455.08 / $2,361.54
| Professional | | $871.47 | $1,455.08 | $2,361.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.33 / $2,368.44 / $3,709.41
| Facility | | $1,969.33 | $2,368.44 | $3,709.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.76 / $2,401.80 / $4,526.08
| Professional | | $1,939.76 | $2,401.80 | $4,526.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,824.65 / $2,136.21 / $2,539.23
| Professional | | $1,824.65 | $2,136.21 | $2,539.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.06 / $1,285.78 / $1,818.85
| Professional | | $755.06 | $1,285.78 | $1,818.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.08 / $2,110.08 / $2,110.08
| Professional | | $2,110.08 | $2,110.08 | $2,110.08 |