- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.40 / $1,160.25 / $1,527.65
| Professional | | $1,125.40 | $1,160.25 | $1,527.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,641.72 / $4,918.63 / $5,823.08
| Facility | | $3,641.72 | $4,918.63 | $5,823.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.58 / $1,353.62 / $2,263.83
| Professional | | $1,150.58 | $1,353.62 | $2,263.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.09 / $1,207.09 / $1,489.85
| Facility | | $1,207.09 | $1,207.09 | $1,489.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.18 / $1,207.09 / $1,207.09
| Professional | | $881.18 | $1,207.09 | $1,207.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.08 / $1,285.01 / $2,141.67
| Professional | | $875.08 | $1,285.01 | $2,141.67 |