- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.85 / $2,075.80 / $4,981.92
| Facility | | $1,556.85 | $2,075.80 | $4,981.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.09 / $1,536.09 / $1,556.85
| Professional | | $1,536.09 | $1,536.09 | $1,556.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.27 / $1,349.27 / $1,821.51
| Facility | | $1,349.27 | $1,349.27 | $1,821.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.08 / $2,385.08 / $2,981.34
| Professional | | $2,385.08 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.79 / $1,702.16 / $6,953.93
| Facility | | $1,390.79 | $1,702.16 | $6,953.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $871.84 / $2,075.80
| Professional | | $871.84 | $871.84 | $2,075.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $871.84 / $1,245.48
| Professional | | $871.84 | $871.84 | $1,245.48 |