- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.54 / $1,429.16 / $1,461.20
| Professional | | $1,079.54 | $1,429.16 | $1,461.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.59 / $995.59 / $1,146.89
| Professional | | $995.59 | $995.59 | $1,146.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.03 / $511.03 / $511.03
| Facility | | $511.03 | $511.03 | $511.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.38 / $511.03 / $511.03
| Professional | | $434.38 | $511.03 | $511.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.30 / $837.78 / $1,117.06
| Professional | | $514.30 | $837.78 | $1,117.06 |