- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.68 / $947.79 / $1,123.71
| Professional | | $812.68 | $947.79 | $1,123.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.58 / $1,214.64 / $1,726.36
| Professional | | $938.58 | $1,214.64 | $1,726.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.78 / $1,348.45 / $1,939.00
| Professional | | $926.78 | $1,348.45 | $1,939.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.54 / $1,303.41 / $1,999.50
| Professional | | $1,126.54 | $1,303.41 | $1,999.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.68 / $1,003.96 / $1,466.54
| Professional | | $812.68 | $1,003.96 | $1,466.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.02 / $1,166.38 / $1,808.55
| Professional | | $854.02 | $1,166.38 | $1,808.55 |