- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.04 / $920.29 / $4,983.24
| Professional | | $783.04 | $920.29 | $4,983.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.03 / $1,289.03 / $3,318.94
| Professional | | $1,289.03 | $1,289.03 | $3,318.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.65 / $1,389.03 / $3,318.94
| Professional | | $734.65 | $1,389.03 | $3,318.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.94 / $1,348.76 / $3,318.94
| Professional | | $982.94 | $1,348.76 | $3,318.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.35 / $1,335.92 / $4,073.63
| Professional | | $1,097.35 | $1,335.92 | $4,073.63 |