- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.66 / $1,028.13 / $1,873.06
| Professional | | $980.66 | $1,028.13 | $1,873.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.67 / $1,457.67 / $1,637.94
| Professional | | $1,457.67 | $1,457.67 | $1,637.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.14 / $1,618.14 / $1,618.14
| Facility | | $1,618.14 | $1,618.14 | $1,618.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.24 / $1,181.24 / $1,618.14
| Professional | | $1,181.24 | $1,181.24 | $1,618.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.25 / $2,396.07 / $3,450.34
| Professional | | $1,677.25 | $2,396.07 | $3,450.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.49 / $1,195.36 / $1,905.41
| Professional | | $994.49 | $1,195.36 | $1,905.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.36 / $1,321.36 / $1,677.25
| Professional | | $1,321.36 | $1,321.36 | $1,677.25 |