- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.72 / $1,828.72 / $3,197.42
| Professional | | $1,828.72 | $1,828.72 | $3,197.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.23 / $2,070.23 / $2,070.23
| Facility | | $2,070.23 | $2,070.23 | $2,070.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.20 / $1,987.71 / $3,312.85
| Facility | | $1,725.20 | $1,987.71 | $3,312.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.71 / $1,828.71 / $1,828.71
| Professional | | $1,828.71 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.20 / $1,987.71 / $3,312.85
| Facility | | $1,725.20 | $1,987.71 | $3,312.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.71 / $1,828.71 / $1,828.71
| Professional | | $1,828.71 | $1,828.71 | $1,828.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.28 / $1,828.72 / $3,261.96
| Professional | | $1,737.28 | $1,828.72 | $3,261.96 |