- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.44 / $1,072.44 / $1,286.93
| Facility | | $1,072.44 | $1,072.44 | $1,286.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.19 / $928.45 / $1,282.77
| Professional | | $832.19 | $928.45 | $1,282.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,904.64 / $1,904.64 / $2,257.76
| Facility | | $1,904.64 | $1,904.64 | $2,257.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.24 / $1,157.24 / $1,215.44
| Professional | | $1,157.24 | $1,157.24 | $1,215.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,551.30 / $1,551.30 / $1,551.30
| Facility | | $1,551.30 | $1,551.30 | $1,551.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.45 / $1,132.45 / $1,551.30
| Professional | | $1,132.45 | $1,132.45 | $1,551.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.10 / $1,542.10 / $4,759.68
| Professional | | $1,542.10 | $1,542.10 | $4,759.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.47 / $950.20 / $1,431.35
| Professional | | $633.47 | $950.20 | $1,431.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.52 / $1,569.17 / $1,997.13
| Professional | | $1,426.52 | $1,569.17 | $1,997.13 |