- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.03 / $813.24 / $1,064.55
| Professional | | $614.03 | $813.24 | $1,064.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.60 / $468.34 / $953.74
| Professional | | $160.60 | $468.34 | $953.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.67 / $809.48 / $1,474.50
| Professional | | $552.67 | $809.48 | $1,474.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.47 / $860.31 / $1,329.58
| Professional | | $720.47 | $860.31 | $1,329.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.96 / $530.38 / $894.89
| Professional | | $102.96 | $530.38 | $894.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.48 / $966.48 / $1,314.06
| Professional | | $752.48 | $966.48 | $1,314.06 |