- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.27 / $793.52 / $874.31
| Professional | | $593.27 | $793.52 | $874.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.04 / $930.53 / $1,363.92
| Professional | | $719.04 | $930.53 | $1,363.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.14 / $1,068.61 / $1,603.83
| Professional | | $742.14 | $1,068.61 | $1,603.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.76 / $1,030.60 / $1,581.01
| Professional | | $890.76 | $1,030.60 | $1,581.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.27 / $795.73 / $874.31
| Professional | | $593.27 | $795.73 | $874.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.08 / $909.29 / $1,430.03
| Professional | | $631.08 | $909.29 | $1,430.03 |