- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.37 / $1,790.37 / $2,237.96
| Professional | | $1,790.37 | $1,790.37 | $2,237.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.00 / $1,526.21 / $1,844.64
| Facility | | $1,193.00 | $1,526.21 | $1,844.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.00 / $1,967.17 / $5,903.12
| Professional | | $836.00 | $1,967.17 | $5,903.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.00 / $1,526.21 / $1,986.54
| Facility | | $1,193.00 | $1,526.21 | $1,986.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.96 / $1,458.65 / $2,128.32
| Professional | | $935.96 | $1,458.65 | $2,128.32 |