- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.62 / $691.59 / $836.24
| Professional | | $576.62 | $691.59 | $836.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.01 / $1,104.71 / $1,313.13
| Facility | | $615.01 | $1,104.71 | $1,313.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.45 / $953.90 / $3,094.73
| Professional | | $324.45 | $953.90 | $3,094.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.60 / $672.89 / $1,104.71
| Facility | | $494.60 | $672.89 | $1,104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.65 / $994.24 / $1,586.59
| Professional | | $603.65 | $994.24 | $1,586.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.11 / $923.44 / $1,190.24
| Professional | | $646.11 | $923.44 | $1,190.24 |