- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.14 / $521.71 / $836.72
| Professional | | $365.14 | $521.71 | $836.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.56 / $1,236.65 / $1,895.73
| Professional | | $697.56 | $1,236.65 | $1,895.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.57 / $1,309.28 / $2,283.28
| Professional | | $789.57 | $1,309.28 | $2,283.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.06 / $1,225.01 / $2,082.00
| Professional | | $761.06 | $1,225.01 | $2,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.37 / $1,059.45 / $2,800.00
| Professional | | $572.37 | $1,059.45 | $2,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.54 / $936.61 / $1,995.37
| Professional | | $557.54 | $936.61 | $1,995.37 |