- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $436.52 / $1,148.15
| Professional | | $416.87 | $436.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $1,862.09
| Professional | | $954.99 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,047.13
| Professional | | $562.34 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $933.25 / $1,513.56
| Professional | | $501.19 | $933.25 | $1,513.56 |