- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.31 / $497.05 / $632.14
| Professional | | $449.31 | $497.05 | $632.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.94 / $570.94 / $731.22
| Facility | | $570.94 | $570.94 | $731.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.37 / $749.37 / $1,511.33
| Professional | | $749.37 | $749.37 | $1,511.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.46 / $748.53 / $1,057.35
| Professional | | $516.46 | $748.53 | $1,057.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.39 / $746.17 / $1,057.35
| Professional | | $550.39 | $746.17 | $1,057.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.40 / $660.00 / $1,762.47
| Professional | | $596.40 | $660.00 | $1,762.47 |