- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.12 / $1,428.58 / $1,689.74
| Facility | | $1,408.12 | $1,428.58 | $1,689.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.30 / $1,428.58 / $1,939.10
| Professional | | $1,112.30 | $1,428.58 | $1,939.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.58 / $2,881.67 / $5,341.71
| Facility | | $2,378.58 | $2,881.67 | $5,341.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.67 / $1,556.88 / $2,148.48
| Professional | | $1,497.67 | $1,556.88 | $2,148.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.28 / $1,486.28 / $1,611.59
| Facility | | $1,486.28 | $1,486.28 | $1,611.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.98 / $1,486.28 / $1,621.68
| Professional | | $1,084.98 | $1,486.28 | $1,621.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.89 / $1,428.89 / $1,428.89
| Facility | | $1,428.89 | $1,428.89 | $1,428.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.88 / $1,299.76 / $1,934.63
| Professional | | $988.88 | $1,299.76 | $1,934.63 |