- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.20 / $1,342.20 / $3,446.18
| Facility | | $1,342.20 | $1,342.20 | $3,446.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.20 / $1,656.13 / $3,446.18
| Professional | | $1,342.20 | $1,656.13 | $3,446.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.78 / $4,142.78 / $4,142.78
| Facility | | $4,142.78 | $4,142.78 | $4,142.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.13 / $1,898.20 / $4,142.78
| Professional | | $1,866.13 | $1,898.20 | $4,142.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,479.82 / $2,479.82 / $3,049.81
| Facility | | $2,479.82 | $2,479.82 | $3,049.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.27 / $2,426.54 / $2,620.54
| Professional | | $1,810.27 | $2,426.54 | $2,620.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.76 / $3,314.22 / $5,385.61
| Professional | | $2,303.76 | $3,314.22 | $5,385.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.70 / $1,550.09 / $2,768.09
| Professional | | $1,213.70 | $1,550.09 | $2,768.09 |