- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.22 / $815.73 / $840.08
| Professional | | $706.22 | $815.73 | $840.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.85 / $852.25 / $1,053.00
| Professional | | $782.85 | $852.25 | $1,053.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.10 / $1,120.10 / $1,120.10
| Facility | | $1,120.10 | $1,120.10 | $1,120.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.61 / $1,140.20 / $2,371.88
| Professional | | $115.61 | $1,140.20 | $2,371.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.03 / $139.03 / $139.03
| Professional | | $139.03 | $139.03 | $139.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.66 / $688.37 / $918.63
| Professional | | $412.66 | $688.37 | $918.63 |