- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.28 / $1,008.31 / $1,227.09
| Facility | | $989.28 | $1,008.31 | $1,227.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.14 / $1,043.61 / $1,440.33
| Professional | | $845.14 | $1,043.61 | $1,440.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.85 / $2,198.66 / $4,557.88
| Facility | | $1,876.85 | $2,198.66 | $4,557.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.51 / $1,124.51 / $1,605.57
| Professional | | $1,124.51 | $1,124.51 | $1,605.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.48 / $1,408.48 / $1,408.48
| Facility | | $1,408.48 | $1,408.48 | $1,408.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.19 / $1,282.71 / $1,450.73
| Professional | | $1,028.19 | $1,282.71 | $1,450.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.23 / $1,012.25 / $1,456.14
| Professional | | $765.23 | $1,012.25 | $1,456.14 |