- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.34 / $441.34 / $547.88
| Professional | | $441.34 | $441.34 | $547.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.62 / $420.91 / $3,307.00
| Professional | | $298.62 | $420.91 | $3,307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.09 / $537.61 / $1,133.02
| Professional | | $371.09 | $537.61 | $1,133.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.67 / $991.67 / $991.67
| Professional | | $453.67 | $991.67 | $991.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.97 / $718.16 / $1,181.54
| Professional | | $458.97 | $718.16 | $1,181.54 |