- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.39 / $1,659.16 / $8,970.52
| Professional | | $1,470.39 | $1,659.16 | $8,970.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.26 / $2,736.26 / $2,736.26
| Facility | | $2,736.26 | $2,736.26 | $2,736.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.88 / $2,736.25 / $4,790.09
| Professional | | $1,634.88 | $2,736.25 | $4,790.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.93 / $2,320.10 / $3,180.84
| Facility | | $1,683.93 | $2,320.10 | $3,180.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.15 / $2,801.68 / $4,668.60
| Professional | | $1,716.15 | $2,801.68 | $4,668.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.44 / $2,941.75 / $3,660.92
| Professional | | $2,369.44 | $2,941.75 | $3,660.92 |