- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.52 / $1,036.52 / $1,243.82
| Facility | | $1,036.52 | $1,036.52 | $1,243.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.31 / $822.07 / $1,036.52
| Professional | | $804.31 | $822.07 | $1,036.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,840.86 / $1,840.86 / $2,182.16
| Facility | | $1,840.86 | $1,840.86 | $2,182.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.32 / $1,029.32 / $1,075.18
| Professional | | $1,029.32 | $1,029.32 | $1,075.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.56 / $1,329.56 / $1,329.56
| Facility | | $1,329.56 | $1,329.56 | $1,329.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.58 / $970.58 / $1,329.56
| Professional | | $970.58 | $970.58 | $1,329.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.45 / $1,490.45 / $4,600.27
| Professional | | $1,490.45 | $1,490.45 | $4,600.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.25 / $918.38 / $1,547.32
| Professional | | $612.25 | $918.38 | $1,547.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.73 / $1,323.00 / $1,683.82
| Professional | | $1,202.73 | $1,323.00 | $1,683.82 |