- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.40 / $948.80 / $1,147.18
| Professional | | $752.40 | $948.80 | $1,147.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.23 / $1,221.94 / $1,726.19
| Professional | | $944.23 | $1,221.94 | $1,726.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.26 / $1,376.61 / $1,949.59
| Professional | | $920.26 | $1,376.61 | $1,949.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.36 / $1,304.36 / $2,000.97
| Professional | | $1,127.36 | $1,304.36 | $2,000.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.40 / $1,052.74 / $1,147.18
| Professional | | $752.40 | $1,052.74 | $1,147.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.38 / $1,197.82 / $1,796.51
| Professional | | $845.38 | $1,197.82 | $1,796.51 |