- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.31 / $1,509.80 / $1,758.45
| Facility | | $1,481.31 | $1,509.80 | $1,758.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.47 / $1,481.31 / $2,183.64
| Professional | | $1,312.47 | $1,481.31 | $2,183.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,819.01 / $3,167.44 / $5,750.78
| Facility | | $2,819.01 | $3,167.44 | $5,750.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.25 / $1,624.28 / $2,367.44
| Professional | | $1,614.25 | $1,624.28 | $2,367.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.71 / $2,373.71 / $2,373.71
| Facility | | $2,373.71 | $2,373.71 | $2,373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.65 / $2,017.65 / $2,444.92
| Professional | | $2,017.65 | $2,017.65 | $2,444.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.54 / $1,490.83 / $2,113.41
| Professional | | $1,124.54 | $1,490.83 | $2,113.41 |