- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.23 / $1,093.36 / $1,429.69
| Professional | | $1,004.23 | $1,093.36 | $1,429.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.00 / $1,143.10 / $1,306.58
| Professional | | $885.00 | $1,143.10 | $1,306.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.75 / $1,092.04 / $2,275.73
| Professional | | $846.75 | $1,092.04 | $2,275.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.85 / $1,187.90 / $1,973.86
| Professional | | $920.85 | $1,187.90 | $1,973.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.93 / $1,007.40 / $1,699.43
| Professional | | $764.93 | $1,007.40 | $1,699.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.20 / $723.20 / $1,295.26
| Professional | | $723.20 | $723.20 | $1,295.26 |