- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.16 / $840.17 / $1,193.76
| Professional | | $598.16 | $840.17 | $1,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.97 / $1,141.97 / $3,668.19
| Professional | | $1,141.97 | $1,141.97 | $3,668.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.92 / $1,253.26 / $2,320.76
| Professional | | $790.92 | $1,253.26 | $2,320.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.55 / $1,266.40 / $2,320.76
| Professional | | $939.55 | $1,266.40 | $2,320.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.54 / $1,457.64 / $4,237.46
| Professional | | $1,055.54 | $1,457.64 | $4,237.46 |