- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.03 / $926.76 / $1,411.86
| Professional | | $804.03 | $926.76 | $1,411.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.87 / $1,198.18 / $1,702.84
| Professional | | $925.87 | $1,198.18 | $1,702.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.15 / $1,332.31 / $1,905.78
| Professional | | $909.15 | $1,332.31 | $1,905.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.11 / $1,286.72 / $1,973.90
| Professional | | $1,112.11 | $1,286.72 | $1,973.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.03 / $1,110.25 / $1,657.03
| Professional | | $804.03 | $1,110.25 | $1,657.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.24 / $1,220.34 / $1,769.23
| Professional | | $768.24 | $1,220.34 | $1,769.23 |