- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.76 / $1,029.72 / $1,060.46
| Professional | | $757.76 | $1,029.72 | $1,060.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.80 / $1,075.83 / $1,281.48
| Professional | | $961.80 | $1,075.83 | $1,281.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.95 / $1,201.95 / $1,201.95
| Facility | | $1,201.95 | $1,201.95 | $1,201.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.05 / $1,223.23 / $2,160.94
| Professional | | $124.05 | $1,223.23 | $2,160.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.51 / $175.51 / $175.51
| Professional | | $175.51 | $175.51 | $175.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.70 / $738.61 / $986.13
| Professional | | $442.70 | $738.61 | $986.13 |