- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.17 / $625.62 / $699.32
| Professional | | $515.17 | $625.62 | $699.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,667.07 / $2,251.58 / $2,665.61
| Facility | | $1,667.07 | $2,251.58 | $2,665.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.70 / $619.65 / $1,036.31
| Professional | | $526.70 | $619.65 | $1,036.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $740.83 / $740.83
| Facility | | $682.00 | $740.83 | $740.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.80 / $740.83 / $740.83
| Professional | | $540.80 | $740.83 | $740.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.58 / $588.23 / $980.39
| Professional | | $460.58 | $588.23 | $980.39 |