- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.51 / $957.64 / $1,076.05
| Professional | | $729.51 | $957.64 | $1,076.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.45 / $1,149.76 / $1,678.86
| Professional | | $888.45 | $1,149.76 | $1,678.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.02 / $1,310.68 / $1,947.18
| Professional | | $908.02 | $1,310.68 | $1,947.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.45 / $1,268.58 / $1,946.09
| Professional | | $1,096.45 | $1,268.58 | $1,946.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.51 / $967.36 / $1,076.05
| Professional | | $729.51 | $967.36 | $1,076.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.24 / $1,125.84 / $1,946.09
| Professional | | $741.24 | $1,125.84 | $1,946.09 |