- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.68 / $1,271.18 / $1,342.87
| Facility | | $1,197.68 | $1,271.18 | $1,342.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.88 / $1,271.18 / $1,304.44
| Professional | | $1,064.88 | $1,271.18 | $1,304.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.50 / $1,504.20 / $1,504.20
| Professional | | $1,136.50 | $1,504.20 | $1,504.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.00 / $1,576.00 / $1,959.05
| Professional | | $1,060.00 | $1,576.00 | $1,959.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,136.66 / $2,421.00
| Facility | | $375.00 | $1,136.66 | $2,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.73 / $1,179.36 / $2,073.59
| Professional | | $899.73 | $1,179.36 | $2,073.59 |