- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,905.46
| Facility | | $758.58 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,778.28
| Professional | | $758.58 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $4,265.80
| Facility | | $776.25 | $1,071.52 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,148.15 / $2,454.71
| Professional | | $1,023.29 | $1,148.15 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,479.11 / $8,511.38
| Facility | | $1,445.44 | $1,479.11 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $3,311.31
| Professional | | $1,071.52 | $1,071.52 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,344.23
| Facility | | $954.99 | $1,288.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,513.56
| Professional | | $707.95 | $1,023.29 | $1,513.56 |