- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.08 / $1,466.49 / $5,357.14
| Professional | | $1,100.08 | $1,466.49 | $5,357.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.50 / $1,640.50 / $1,640.50
| Facility | | $1,640.50 | $1,640.50 | $1,640.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.05 / $1,640.50 / $1,904.30
| Professional | | $942.05 | $1,640.50 | $1,904.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.39 / $1,114.29 / $1,640.50
| Facility | | $810.39 | $1,114.29 | $1,640.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.14 / $1,640.50 / $2,254.57
| Professional | | $1,004.14 | $1,640.50 | $2,254.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.34 / $1,715.12 / $2,500.01
| Professional | | $1,395.34 | $1,715.12 | $2,500.01 |