- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.96 / $1,435.05 / $3,450.39
| Professional | | $1,155.96 | $1,435.05 | $3,450.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.58 / $1,303.91 / $1,655.91
| Professional | | $1,266.58 | $1,303.91 | $1,655.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,076.35 / $3,076.35 / $3,076.35
| Facility | | $3,076.35 | $3,076.35 | $3,076.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.52 / $1,793.82 / $3,120.86
| Professional | | $1,157.52 | $1,793.82 | $3,120.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,209.90 / $1,560.77 / $2,656.36
| Professional | | $1,209.90 | $1,560.77 | $2,656.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.67 / $1,415.37 / $2,323.69
| Professional | | $1,006.67 | $1,415.37 | $2,323.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.77 / $1,391.39 / $1,719.30
| Professional | | $1,205.77 | $1,391.39 | $1,719.30 |