- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.81 / $1,036.38 / $1,459.78
| Professional | | $768.81 | $1,036.38 | $1,459.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.18 / $1,319.03 / $1,826.51
| Professional | | $1,121.18 | $1,319.03 | $1,826.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,217.05 / $1,629.32
| Facility | | $1,217.05 | $1,217.05 | $1,629.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,034.49 / $1,034.49
| Professional | | $1,034.49 | $1,034.49 | $1,034.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.84 / $1,118.19 / $1,863.65
| Professional | | $800.84 | $1,118.19 | $1,863.65 |