- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.10 / $1,962.48 / $7,344.25
| Professional | | $1,452.10 | $1,962.48 | $7,344.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.25 / $2,155.25 / $2,155.25
| Facility | | $2,155.25 | $2,155.25 | $2,155.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.10 / $1,917.69 / $2,155.25
| Professional | | $1,024.10 | $1,917.69 | $2,155.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.83 / $1,343.02 / $2,155.25
| Facility | | $1,065.83 | $1,343.02 | $2,155.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.63 / $2,042.73 / $2,850.40
| Professional | | $1,305.63 | $2,042.73 | $2,850.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.85 / $2,245.59 / $3,448.60
| Professional | | $1,732.85 | $2,245.59 | $3,448.60 |