- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.49 / $920.30 / $1,042.93
| Professional | | $885.49 | $920.30 | $1,042.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.82 / $1,367.82 / $1,367.82
| Facility | | $1,367.82 | $1,367.82 | $1,367.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.51 / $998.51 / $1,367.82
| Professional | | $998.51 | $998.51 | $1,367.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $1,347.44 / $1,347.44
| Facility | | $1.63 | $1,347.44 | $1,347.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.30 / $1,195.33 / $1,560.38
| Professional | | $1,007.30 | $1,195.33 | $1,560.38 |