- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.49 / $1,233.77 / $4,774.47
| Professional | | $970.49 | $1,233.77 | $4,774.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,535.86 / $1,535.86 / $1,535.86
| Facility | | $1,535.86 | $1,535.86 | $1,535.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.75 / $1,328.71 / $1,535.86
| Professional | | $670.75 | $1,328.71 | $1,535.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.03 / $947.54 / $1,270.06
| Facility | | $758.03 | $947.54 | $1,270.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.01 / $1,420.38 / $1,986.19
| Professional | | $864.01 | $1,420.38 | $1,986.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.43 / $1,532.71 / $1,734.70
| Professional | | $988.43 | $1,532.71 | $1,734.70 |