- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.65 / $991.49 / $1,232.14
| Professional | | $824.65 | $991.49 | $1,232.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.00 / $1,332.94 / $1,856.71
| Professional | | $1,030.00 | $1,332.94 | $1,856.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.78 / $1,478.56 / $2,077.96
| Professional | | $970.78 | $1,478.56 | $2,077.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.22 / $1,400.22 / $2,148.02
| Professional | | $1,210.22 | $1,400.22 | $2,148.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.65 / $1,201.20 / $1,232.14
| Professional | | $824.65 | $1,201.20 | $1,232.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.50 / $1,323.15 / $2,148.02
| Professional | | $862.50 | $1,323.15 | $2,148.02 |