- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.63 / $1,304.74 / $1,469.58
| Professional | | $1,082.63 | $1,304.74 | $1,469.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,503.29 / $4,731.64 / $5,601.72
| Facility | | $3,503.29 | $4,731.64 | $5,601.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,375.64 / $1,618.40 / $2,240.73
| Professional | | $1,375.64 | $1,618.40 | $2,240.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.22 / $1,599.98 / $1,599.98
| Facility | | $1,433.22 | $1,599.98 | $1,599.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.99 / $1,599.98 / $1,599.98
| Professional | | $1,167.99 | $1,599.98 | $1,599.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.25 / $1,415.06 / $2,060.27
| Professional | | $1,117.25 | $1,415.06 | $2,060.27 |