- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.01 / $2,258.25 / $2,258.25
| Professional | | $1,465.01 | $2,258.25 | $2,258.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.17 / $3,863.67 / $7,162.03
| Facility | | $2,982.17 | $3,863.67 | $7,162.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.36 / $1,780.13 / $2,517.29
| Professional | | $1,696.36 | $1,780.13 | $2,517.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.07 / $1,743.07 / $2,464.42
| Facility | | $1,743.07 | $1,743.07 | $2,464.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.44 / $1,272.44 / $1,743.07
| Professional | | $1,272.44 | $1,272.44 | $1,743.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.77 / $2,714.77 / $2,714.77
| Professional | | $2,714.77 | $2,714.77 | $2,714.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.97 / $2,258.25 / $2,258.25
| Professional | | $1,887.97 | $2,258.25 | $2,258.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.18 / $1,672.78 / $3,846.86
| Professional | | $1,115.18 | $1,672.78 | $3,846.86 |