- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.12 / $791.52 / $1,024.40
| Professional | | $688.12 | $791.52 | $1,024.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.44 / $1,110.93 / $1,588.60
| Professional | | $858.44 | $1,110.93 | $1,588.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.48 / $1,236.02 / $1,772.89
| Professional | | $853.48 | $1,236.02 | $1,772.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.51 / $1,200.40 / $1,841.48
| Professional | | $1,037.51 | $1,200.40 | $1,841.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.47 / $791.52 / $1,024.40
| Professional | | $680.47 | $791.52 | $1,024.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.69 / $1,116.05 / $1,747.38
| Professional | | $769.69 | $1,116.05 | $1,747.38 |