- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.72 / $965.95 / $2,641.29
| Professional | | $502.72 | $965.95 | $2,641.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.52 / $1,206.03 / $1,913.27
| Professional | | $1,141.52 | $1,206.03 | $1,913.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.33 / $870.71 / $1,630.50
| Professional | | $689.33 | $870.71 | $1,630.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.87 / $870.71 / $1,630.50
| Professional | | $550.87 | $870.71 | $1,630.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.38 / $1,218.79 / $2,196.65
| Professional | | $640.38 | $1,218.79 | $2,196.65 |