- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.88 / $777.66 / $822.87
| Professional | | $576.88 | $777.66 | $822.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.74 / $989.74 / $1,565.33
| Professional | | $989.74 | $989.74 | $1,565.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.58 / $1,116.58 / $1,116.58
| Facility | | $1,116.58 | $1,116.58 | $1,116.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.10 / $1,116.58 / $1,116.58
| Professional | | $949.10 | $1,116.58 | $1,116.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.34 / $1,019.30 / $1,790.16
| Professional | | $615.34 | $1,019.30 | $1,790.16 |