- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.17 / $848.14 / $848.14
| Professional | | $736.17 | $848.14 | $848.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.64 / $2,240.64 / $2,240.64
| Professional | | $2,240.64 | $2,240.64 | $2,240.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.24 / $1,067.21 / $2,240.64
| Professional | | $824.24 | $1,067.21 | $2,240.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.24 / $1,067.21 / $2,240.64
| Professional | | $824.24 | $1,067.21 | $2,240.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.69 / $917.73 / $2,750.13
| Professional | | $700.69 | $917.73 | $2,750.13 |