- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.41 / $942.12 / $1,449.97
| Professional | | $738.41 | $942.12 | $1,449.97 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $208.67 / $208.67 / $217.50
| Professional | 55 | $208.67 | $208.67 | $217.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.27 / $1,153.77 / $1,712.05
| Professional | | $901.27 | $1,153.77 | $1,712.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.25 / $1,319.25 / $1,319.25
| Facility | | $1,319.25 | $1,319.25 | $1,319.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.07 / $1,620.44 / $1,939.54
| Professional | | $1,110.07 | $1,620.44 | $1,939.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.40 / $1,274.32 / $1,954.87
| Professional | | $1,101.40 | $1,274.32 | $1,954.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.41 / $1,020.29 / $1,675.22
| Professional | | $738.41 | $1,020.29 | $1,675.22 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $208.67 / $208.67 / $208.67
| Professional | 55 | $208.67 | $208.67 | $208.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.72 / $1,228.60 / $1,636.69
| Professional | | $742.72 | $1,228.60 | $1,636.69 |