- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.33 / $756.33 / $872.69
| Professional | | $756.33 | $756.33 | $872.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.52 / $950.52 / $1,139.15
| Facility | | $950.52 | $950.52 | $1,139.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.88 / $883.57 / $1,013.30
| Professional | | $693.88 | $883.57 | $1,013.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.52 / $950.52 / $1,139.15
| Facility | | $950.52 | $950.52 | $1,139.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.88 / $950.52 / $1,013.30
| Professional | | $693.88 | $950.52 | $1,013.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.89 / $1,164.74 / $1,288.70
| Professional | | $707.89 | $1,164.74 | $1,288.70 |