- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.36 / $897.33 / $1,151.27
| Professional | | $728.36 | $897.33 | $1,151.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.38 / $1,067.50 / $1,542.30
| Professional | | $724.38 | $1,067.50 | $1,542.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.39 / $994.93 / $1,350.59
| Professional | | $900.39 | $994.93 | $1,350.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.86 / $1,082.58 / $1,850.96
| Professional | | $828.86 | $1,082.58 | $1,850.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.69 / $1,121.78 / $2,032.60
| Professional | | $871.69 | $1,121.78 | $2,032.60 |