- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.14 / $874.09 / $1,044.70
| Professional | | $694.14 | $874.09 | $1,044.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.21 / $1,128.75 / $1,605.64
| Professional | | $872.21 | $1,128.75 | $1,605.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.05 / $1,253.64 / $1,796.20
| Professional | | $858.05 | $1,253.64 | $1,796.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.64 / $1,213.28 / $1,861.23
| Professional | | $1,048.64 | $1,213.28 | $1,861.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.14 / $950.85 / $1,044.70
| Professional | | $694.14 | $950.85 | $1,044.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.61 / $1,098.45 / $1,667.58
| Professional | | $784.61 | $1,098.45 | $1,667.58 |