- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.54 / $702.76 / $861.02
| Professional | | $672.54 | $702.76 | $861.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.75 / $562.62 / $728.22
| Professional | | $434.75 | $562.62 | $728.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.81 / $1,005.81 / $1,005.81
| Facility | | $1,005.81 | $1,005.81 | $1,005.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.36 / $859.66 / $1,097.13
| Professional | | $667.36 | $859.66 | $1,097.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.33 / $671.06 / $1,044.17
| Professional | | $538.33 | $671.06 | $1,044.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.54 / $672.54 / $838.53
| Professional | | $672.54 | $672.54 | $838.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.33 / $738.34 / $982.87
| Professional | | $538.33 | $738.34 | $982.87 |