- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.71 / $891.89 / $1,292.08
| Professional | | $617.71 | $891.89 | $1,292.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.53 / $916.31 / $1,644.82
| Professional | | $655.53 | $916.31 | $1,644.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.02 / $983.05 / $1,542.99
| Professional | | $679.02 | $983.05 | $1,542.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,475.43 / $5,985.68 / $6,982.28
| Professional | | $4,475.43 | $5,985.68 | $6,982.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.63 / $1,201.75 / $2,097.30
| Professional | | $822.63 | $1,201.75 | $2,097.30 |