- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $870.96 / $1,862.09
| Professional | | $776.25 | $870.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,995.26 / $2,398.83
| Professional | | $1,778.28 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,258.93 / $2,238.72
| Professional | | $1,230.27 | $1,258.93 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $3,235.94
| Facility | | $794.33 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $3,235.94
| Professional | | $977.24 | $1,584.89 | $3,235.94 |