- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.33 / $2,856.38 / $2,899.85
| Facility | | $1,317.33 | $2,856.38 | $2,899.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.31 / $1,002.24 / $1,330.57
| Professional | | $859.31 | $1,002.24 | $1,330.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.37 / $1,972.60 / $2,272.07
| Facility | | $1,530.37 | $1,972.60 | $2,272.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.89 / $1,073.99 / $1,877.20
| Professional | | $912.89 | $1,073.99 | $1,877.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,793.61 / $3,793.61 / $3,793.61
| Facility | | $3,793.61 | $3,793.61 | $3,793.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.65 / $1,327.95 / $2,477.35
| Professional | | $990.65 | $1,327.95 | $2,477.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.85 / $1,213.83 / $1,611.74
| Professional | | $865.85 | $1,213.83 | $1,611.74 |