- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.92 / $647.94 / $2,677.20
| Professional | | $507.92 | $647.94 | $2,677.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.63 / $1,046.33 / $2,363.09
| Professional | | $887.63 | $1,046.33 | $2,363.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.64 / $880.08 / $1,138.42
| Professional | | $535.64 | $880.08 | $1,138.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.56 / $846.77 / $1,138.42
| Professional | | $487.56 | $846.77 | $1,138.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.70 / $916.34 / $2,663.87
| Professional | | $765.70 | $916.34 | $2,663.87 |