- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $645.65
| Professional | | $309.03 | $436.52 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,000.00
| Professional | | $660.69 | $812.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,288.25
| Professional | | $524.81 | $776.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $1,047.13
| Professional | | $457.09 | $870.96 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $676.08 / $1,023.29
| Professional | | $346.74 | $676.08 | $1,023.29 |