- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.46 / $1,154.71 / $6,092.13
| Professional | | $970.46 | $1,154.71 | $6,092.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.49 / $1,864.49 / $1,864.49
| Facility | | $1,864.49 | $1,864.49 | $1,864.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.65 / $1,864.49 / $3,316.57
| Professional | | $1,079.65 | $1,864.49 | $3,316.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.47 / $1,539.61 / $2,118.88
| Facility | | $1,109.47 | $1,539.61 | $2,118.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.29 / $1,903.92 / $3,172.60
| Professional | | $1,166.29 | $1,903.92 | $3,172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.85 / $1,962.87 / $2,481.52
| Professional | | $1,615.85 | $1,962.87 | $2,481.52 |