- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $933.25 / $1,412.54
| Professional | | $380.19 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $724.44 / $1,318.26
| Professional | | $316.23 | $724.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,513.56
| Professional | | $426.58 | $616.60 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $1,621.81
| Professional | | $389.05 | $954.99 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $954.99 / $1,698.24
| Professional | | $371.54 | $954.99 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $954.99 / $1,621.81
| Professional | | $416.87 | $954.99 | $1,621.81 |