- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.09 / $987.46 / $1,100.31
| Professional | | $754.09 | $987.46 | $1,100.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.55 / $1,180.94 / $1,733.13
| Professional | | $912.55 | $1,180.94 | $1,733.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.51 / $1,352.52 / $2,009.00
| Professional | | $936.51 | $1,352.52 | $2,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.90 / $1,309.60 / $2,009.01
| Professional | | $1,131.90 | $1,309.60 | $2,009.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.09 / $990.03 / $1,100.31
| Professional | | $754.09 | $990.03 | $1,100.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.00 / $1,136.35 / $1,835.78
| Professional | | $807.00 | $1,136.35 | $1,835.78 |