- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.35 / $1,061.49 / $1,142.72
| Professional | | $1,008.35 | $1,061.49 | $1,142.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.17 / $1,787.17 / $1,787.17
| Facility | | $1,787.17 | $1,787.17 | $1,787.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.63 / $1,304.63 / $1,304.63
| Professional | | $1,304.63 | $1,304.63 | $1,304.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.21 / $1,448.21 / $1,448.21
| Facility | | $1,448.21 | $1,448.21 | $1,448.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.67 / $1,309.70 / $4,481.93
| Professional | | $1,103.67 | $1,309.70 | $4,481.93 |