- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.80 / $2,045.19 / $2,045.19
| Professional | | $1,326.80 | $2,045.19 | $2,045.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,700.81 / $3,499.15 / $6,486.33
| Facility | | $2,700.81 | $3,499.15 | $6,486.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.42 / $1,453.36 / $2,279.79
| Professional | | $1,376.42 | $1,453.36 | $2,279.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.54 / $1,654.54 / $2,231.91
| Facility | | $1,654.54 | $1,654.54 | $2,231.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.81 / $1,207.81 / $1,654.54
| Professional | | $1,207.81 | $1,207.81 | $1,654.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,458.65 / $2,458.65 / $2,458.65
| Professional | | $2,458.65 | $2,458.65 | $2,458.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.84 / $2,045.19 / $2,045.19
| Professional | | $1,709.84 | $2,045.19 | $2,045.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.97 / $2,458.65 / $3,363.81
| Professional | | $1,009.97 | $2,458.65 | $3,363.81 |