- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.89 / $957.63 / $1,038.23
| Professional | | $799.89 | $957.63 | $1,038.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.27 / $1,959.50 / $2,438.73
| Professional | | $1,587.27 | $1,959.50 | $2,438.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.10 / $2,029.04 / $3,082.34
| Professional | | $1,090.10 | $2,029.04 | $3,082.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.23 / $2,007.14 / $10,173.00
| Professional | | $1,059.23 | $2,007.14 | $10,173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.23 / $1,827.44 / $2,240.81
| Professional | | $1,059.23 | $1,827.44 | $2,240.81 |