- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.17 / $1,391.57 / $2,226.26
| Professional | | $1,388.17 | $1,391.57 | $2,226.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,086.71 / $2,086.71 / $2,209.46
| Professional | | $2,086.71 | $2,086.71 | $2,209.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,521.21 / $2,521.21 / $2,521.21
| Facility | | $2,521.21 | $2,521.21 | $2,521.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.33 / $2,521.21 / $2,648.68
| Professional | | $1,237.33 | $2,521.21 | $2,648.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.07 / $1,889.90 / $2,778.57
| Facility | | $1,338.07 | $1,889.90 | $2,778.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,524.33 / $2,521.21 / $2,985.54
| Professional | | $1,524.33 | $2,521.21 | $2,985.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.45 / $2,533.12 / $2,901.53
| Professional | | $1,582.45 | $2,533.12 | $2,901.53 |