- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.12 / $645.30 / $811.67
| Professional | | $441.12 | $645.30 | $811.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.91 / $1,381.91 / $1,492.95
| Facility | | $1,381.91 | $1,381.91 | $1,492.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.86 / $722.20 / $1,070.46
| Professional | | $675.86 | $722.20 | $1,070.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.83 / $497.71 / $1,070.46
| Professional | | $425.83 | $497.71 | $1,070.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.45 / $497.71 / $1,070.46
| Professional | | $306.45 | $497.71 | $1,070.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.26 / $821.55 / $1,223.41
| Professional | | $403.26 | $821.55 | $1,223.41 |