- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.55 / $869.75 / $3,746.40
| Professional | | $715.55 | $869.75 | $3,746.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.00 / $949.64 / $1,085.44
| Professional | | $840.00 | $949.64 | $1,085.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.87 / $1,010.91 / $1,896.28
| Professional | | $701.87 | $1,010.91 | $1,896.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.34 / $1,020.56 / $1,642.39
| Professional | | $767.34 | $1,020.56 | $1,642.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.29 / $816.46 / $1,484.37
| Professional | | $606.29 | $816.46 | $1,484.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.90 / $882.44 / $1,077.53
| Professional | | $583.90 | $882.44 | $1,077.53 |