- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.30 / $840.79 / $1,004.09
| Professional | | $667.30 | $840.79 | $1,004.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.68 / $1,085.34 / $1,545.05
| Professional | | $838.68 | $1,085.34 | $1,545.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.92 / $1,204.91 / $1,727.40
| Professional | | $825.92 | $1,204.91 | $1,727.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.07 / $1,167.49 / $1,791.00
| Professional | | $1,009.07 | $1,167.49 | $1,791.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.30 / $912.90 / $1,004.09
| Professional | | $667.30 | $912.90 | $1,004.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.15 / $1,078.32 / $1,423.41
| Professional | | $759.15 | $1,078.32 | $1,423.41 |