- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,981.07 / $6,760.83
| Facility | | $2,187.76 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $5,011.87
| Professional | | $1,318.26 | $1,949.84 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $7,413.10
| Facility | | $1,737.80 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,162.28 / $3,715.35
| Professional | | $2,754.23 | $3,162.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,309.57 / $8,912.51
| Facility | | $4,168.69 | $6,309.57 | $8,912.51 |