- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.65 / $986.94 / $986.94
| Professional | | $969.65 | $986.94 | $986.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.78 / $1,262.78 / $2,932.44
| Professional | | $1,262.78 | $1,262.78 | $2,932.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.00 / $1,409.18 / $1,835.87
| Professional | | $901.00 | $1,409.18 | $1,835.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.76 / $1,219.55 / $1,835.87
| Professional | | $851.76 | $1,219.55 | $1,835.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.99 / $1,153.08 / $3,352.09
| Professional | | $1,030.99 | $1,153.08 | $3,352.09 |