- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.69 / $1,108.46 / $1,108.46
| Professional | | $818.69 | $1,108.46 | $1,108.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.38 / $933.98 / $1,410.78
| Professional | | $767.38 | $933.98 | $1,410.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.41 / $1,108.46 / $1,546.76
| Professional | | $932.41 | $1,108.46 | $1,546.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.96 / $891.59 / $1,387.31
| Professional | | $800.96 | $891.59 | $1,387.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.69 / $1,108.46 / $1,108.46
| Professional | | $818.69 | $1,108.46 | $1,108.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.55 / $1,070.08 / $1,389.40
| Professional | | $978.55 | $1,070.08 | $1,389.40 |