- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.29 / $1,258.04 / $1,585.82
| Facility | | $1,247.29 | $1,258.04 | $1,585.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.95 / $1,314.65 / $1,868.79
| Professional | | $1,061.95 | $1,314.65 | $1,868.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.08 / $2,611.06 / $4,902.85
| Facility | | $2,353.08 | $2,611.06 | $4,902.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.04 / $1,327.04 / $1,952.82
| Professional | | $1,327.04 | $1,327.04 | $1,952.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.14 / $1,618.14 / $1,618.14
| Facility | | $1,618.14 | $1,618.14 | $1,618.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.24 / $1,495.78 / $1,725.02
| Professional | | $1,181.24 | $1,495.78 | $1,725.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.71 / $1,186.91 / $1,800.66
| Professional | | $910.71 | $1,186.91 | $1,800.66 |