- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.37 / $1,958.45 / $2,002.30
| Professional | | $1,479.37 | $1,958.45 | $2,002.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.78 / $1,924.11 / $1,924.11
| Professional | | $1,517.78 | $1,924.11 | $1,924.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.41 / $1,450.41 / $1,450.41
| Facility | | $1,450.41 | $1,450.41 | $1,450.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.84 / $1,232.84 / $1,232.84
| Professional | | $1,232.84 | $1,232.84 | $1,232.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.39 / $1,098.39 / $1,098.39
| Professional | | $1,098.39 | $1,098.39 | $1,098.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.26 / $1,224.31 / $1,744.19
| Professional | | $800.26 | $1,224.31 | $1,744.19 |