- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.67 / $1,872.87 / $4,505.45
| Facility | | $1,320.67 | $1,872.87 | $4,505.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.14 / $1,805.69 / $2,557.30
| Professional | | $1,110.14 | $1,805.69 | $2,557.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.60 / $1,712.26 / $3,547.60
| Facility | | $1,073.60 | $1,712.26 | $3,547.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.45 / $1,605.96 / $2,128.25
| Professional | | $938.45 | $1,605.96 | $2,128.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.96 / $869.34 / $1,495.21
| Facility | | $816.96 | $869.34 | $1,495.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,885.41 / $2,885.41 / $2,885.41
| Professional | | $2,885.41 | $2,885.41 | $2,885.41 |