- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.03 / $2,098.03 / $2,786.94
| Facility | | $2,098.03 | $2,098.03 | $2,786.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,098.03 / $2,098.03 / $2,098.03
| Professional | | $2,098.03 | $2,098.03 | $2,098.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.16 / $2,586.38 / $2,755.39
| Facility | | $2,122.16 | $2,586.38 | $2,755.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.65 / $1,808.65 / $1,808.65
| Professional | | $1,808.65 | $1,808.65 | $1,808.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,680.22 / $3,660.52 / $5,255.21
| Facility | | $2,680.22 | $3,660.52 | $5,255.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.22 / $1,808.65 / $2,025.69
| Professional | | $1,718.22 | $1,808.65 | $2,025.69 |