- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $4,365.16
| Professional | | $912.01 | $1,122.02 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $3,388.44
| Professional | | $912.01 | $1,584.89 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,479.11
| Professional | | $870.96 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $4,570.88
| Professional | | $933.25 | $1,412.54 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $2,951.21
| Professional | | $758.58 | $1,122.02 | $2,951.21 |