- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.64 / $1,945.80 / $2,336.52
| Professional | | $1,556.64 | $1,945.80 | $2,336.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.30 / $2,131.17 / $2,294.35
| Facility | | $1,039.30 | $2,131.17 | $2,294.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.00 / $4,292.00 / $4,714.54
| Professional | | $1,372.00 | $4,292.00 | $4,714.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,701.00 / $1,701.00 / $1,701.00
| Facility | | $1,701.00 | $1,701.00 | $1,701.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.00 / $1,557.00 / $2,133.46
| Professional | | $1,347.00 | $1,557.00 | $2,133.46 |