- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.94 / $1,011.94 / $2,126.34
| Facility | | $1,011.94 | $1,011.94 | $2,126.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.31 / $1,011.94 / $1,052.42
| Professional | | $789.31 | $1,011.94 | $1,052.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.81 / $1,903.07 / $2,126.34
| Facility | | $1,679.81 | $1,903.07 | $2,126.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.82 / $957.82 / $1,321.79
| Professional | | $957.82 | $957.82 | $1,321.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.12 / $2,232.66 / $2,976.88
| Facility | | $1,382.12 | $2,232.66 | $2,976.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.39 / $2,338.96 / $2,870.56
| Professional | | $1,807.39 | $2,338.96 | $2,870.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.64 / $1,020.64 / $2,126.34
| Facility | | $1,020.64 | $1,020.64 | $2,126.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.07 / $1,020.64 / $2,181.21
| Professional | | $745.07 | $1,020.64 | $2,181.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.40 / $1,060.81 / $1,502.81
| Professional | | $530.40 | $1,060.81 | $1,502.81 |