- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.80 / $1,237.45 / $1,505.59
| Facility | | $1,200.80 | $1,237.45 | $1,505.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.19 / $1,239.47 / $1,713.08
| Professional | | $992.19 | $1,239.47 | $1,713.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.44 / $2,712.03 / $4,559.93
| Facility | | $2,237.44 | $2,712.03 | $4,559.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.85 / $1,271.10 / $1,754.13
| Professional | | $1,243.85 | $1,271.10 | $1,754.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.28 / $1,327.28 / $1,327.28
| Facility | | $1,327.28 | $1,327.28 | $1,327.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.91 / $1,327.28 / $1,560.62
| Professional | | $968.91 | $1,327.28 | $1,560.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,407.34 / $2,832.16 / $2,832.16
| Facility | | $2,407.34 | $2,832.16 | $2,832.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.74 / $1,059.70 / $1,680.68
| Professional | | $829.74 | $1,059.70 | $1,680.68 |