- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.33 / $1,240.33 / $1,431.17
| Professional | | $1,240.33 | $1,240.33 | $1,431.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.14 / $1,964.43 / $1,964.43
| Facility | | $1,868.14 | $1,964.43 | $1,964.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.03 / $1,827.35 / $2,094.17
| Professional | | $1,434.03 | $1,827.35 | $2,094.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.14 / $1,964.43 / $1,964.43
| Facility | | $1,868.14 | $1,964.43 | $1,964.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.03 / $1,964.43 / $2,094.17
| Professional | | $1,434.03 | $1,964.43 | $2,094.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.36 / $1,736.36 / $2,938.37
| Professional | | $845.36 | $1,736.36 | $2,938.37 |