- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.50 / $2,014.81 / $2,085.09
| Professional | | $1,423.50 | $2,014.81 | $2,085.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,687.46 / $1,834.20 / $1,834.20
| Professional | | $1,687.46 | $1,834.20 | $1,834.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.28 / $1,414.26 / $2,748.85
| Facility | | $213.28 | $1,414.26 | $2,748.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.14 / $1,414.26 / $3,266.25
| Professional | | $199.14 | $1,414.26 | $3,266.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.12 / $1,671.87 / $2,186.29
| Professional | | $937.12 | $1,671.87 | $2,186.29 |