- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.02 / $568.41 / $983.84
| Professional | | $541.02 | $568.41 | $983.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.69 / $755.45 / $1,200.00
| Professional | | $659.69 | $755.45 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.40 / $855.16 / $1,225.17
| Professional | | $697.40 | $855.16 | $1,225.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.17 / $819.34 / $1,256.91
| Professional | | $636.17 | $819.34 | $1,256.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.02 / $568.41 / $983.84
| Professional | | $541.02 | $568.41 | $983.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.37 / $833.84 / $1,137.52
| Professional | | $628.37 | $833.84 | $1,137.52 |