- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.03 / $841.03 / $1,472.87
| Professional | | $841.03 | $841.03 | $1,472.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.64 / $1,642.64 / $1,642.64
| Facility | | $1,642.64 | $1,642.64 | $1,642.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.64 / $1,642.64 / $1,642.64
| Professional | | $1,642.64 | $1,642.64 | $1,642.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.14 / $1,427.14 / $2,426.78
| Facility | | $1,427.14 | $1,427.14 | $2,426.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.81 / $1,041.81 / $1,427.14
| Professional | | $1,041.81 | $1,041.81 | $1,427.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.08 / $1,100.63 / $1,272.03
| Professional | | $746.08 | $1,100.63 | $1,272.03 |