- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.10 / $1,071.27 / $1,410.51
| Professional | | $1,039.10 | $1,071.27 | $1,410.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.46 / $4,541.46 / $5,376.56
| Facility | | $3,362.46 | $4,541.46 | $5,376.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.35 / $1,553.35 / $2,150.66
| Professional | | $1,320.35 | $1,553.35 | $2,150.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.61 / $1,395.53 / $1,395.53
| Facility | | $1,375.61 | $1,395.53 | $1,395.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.74 / $1,018.74 / $1,018.74
| Professional | | $1,018.74 | $1,018.74 | $1,018.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.98 / $1,186.47 / $1,977.45
| Professional | | $807.98 | $1,186.47 | $1,977.45 |