- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.84 / $1,861.84 / $2,234.21
| Facility | | $1,861.84 | $1,861.84 | $2,234.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.34 / $1,478.15 / $2,226.98
| Professional | | $1,439.34 | $1,478.15 | $2,226.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,306.60 / $3,306.60 / $3,919.64
| Facility | | $3,306.60 | $3,306.60 | $3,919.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.88 / $1,947.88 / $2,056.77
| Professional | | $1,947.88 | $1,947.88 | $2,056.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.34 / $2,561.34 / $2,561.34
| Facility | | $2,561.34 | $2,561.34 | $2,561.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.78 / $1,869.78 / $2,561.34
| Professional | | $1,869.78 | $1,869.78 | $2,561.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.20 / $2,677.20 / $8,263.18
| Professional | | $2,677.20 | $2,677.20 | $8,263.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.75 / $1,649.62 / $2,419.73
| Professional | | $1,099.75 | $1,649.62 | $2,419.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.53 / $2,724.18 / $3,467.14
| Professional | | $2,476.53 | $2,724.18 | $3,467.14 |