- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.83 / $1,784.36 / $1,824.30
| Professional | | $1,347.83 | $1,784.36 | $1,824.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.98 / $1,685.57 / $1,685.57
| Professional | | $1,431.98 | $1,685.57 | $1,685.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.26 / $975.26 / $975.26
| Facility | | $975.26 | $975.26 | $975.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.97 / $975.26 / $975.26
| Professional | | $828.97 | $975.26 | $975.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.84 / $1,378.84 / $1,378.84
| Professional | | $1,378.84 | $1,378.84 | $1,378.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.29 / $1,072.48 / $1,527.88
| Professional | | $731.29 | $1,072.48 | $1,527.88 |