- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.61 / $797.61 / $1,393.43
| Professional | | $797.61 | $797.61 | $1,393.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.89 / $1,060.30 / $1,679.87
| Professional | | $925.89 | $1,060.30 | $1,679.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.56 / $1,196.83 / $1,714.67
| Professional | | $968.56 | $1,196.83 | $1,714.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.57 / $1,146.98 / $1,759.53
| Professional | | $890.57 | $1,146.98 | $1,759.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.61 / $797.61 / $1,393.43
| Professional | | $797.61 | $797.61 | $1,393.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.57 / $1,263.55 / $1,587.94
| Professional | | $890.57 | $1,263.55 | $1,587.94 |