- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.73 / $1,427.45 / $1,441.72
| Facility | | $1,370.73 | $1,427.45 | $1,441.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $1,484.55
| Professional | | $1,427.45 | $1,427.45 | $1,484.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $1,427.45
| Professional | | $1,427.45 | $1,427.45 | $1,427.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.65 / $1,346.65 / $1,479.00
| Facility | | $1,346.65 | $1,346.65 | $1,479.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $1,427.45
| Professional | | $1,427.45 | $1,427.45 | $1,427.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,427.45 / $3,029.96
| Facility | | $319.00 | $1,427.45 | $3,029.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.98 / $1,427.45 / $2,453.60
| Professional | | $1,413.98 | $1,427.45 | $2,453.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $1,481.32
| Facility | | $1,427.45 | $1,427.45 | $1,481.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,481.32 / $1,481.32
| Professional | | $1,427.45 | $1,481.32 | $1,481.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,346.65 / $1,479.00
| Facility | | $555.00 | $1,346.65 | $1,479.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $1,548.65
| Professional | | $1,427.45 | $1,427.45 | $1,548.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,427.45 / $2,184.00
| Professional | | $1,427.45 | $1,427.45 | $2,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.32 / $1,481.32 / $1,481.32
| Facility | | $1,481.32 | $1,481.32 | $1,481.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.45 / $1,481.32 / $1,481.32
| Professional | | $1,427.45 | $1,481.32 | $1,481.32 |