- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.29 / $520.85 / $583.38
| Professional | | $373.29 | $520.85 | $583.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.97 / $1,166.97 / $1,494.54
| Facility | | $1,166.97 | $1,166.97 | $1,494.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.83 / $742.42 / $1,805.08
| Professional | | $629.83 | $742.42 | $1,805.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.09 / $752.13 / $1,093.40
| Professional | | $486.09 | $752.13 | $1,093.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.61 / $723.64 / $1,093.40
| Professional | | $584.61 | $723.64 | $1,093.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.66 / $686.74 / $1,996.41
| Professional | | $600.66 | $686.74 | $1,996.41 |