- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.37 / $895.63 / $4,561.72
| Professional | | $830.37 | $895.63 | $4,561.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.82 / $1,072.42 / $1,225.78
| Professional | | $1,064.82 | $1,072.42 | $1,225.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.30 / $1,144.38 / $2,351.87
| Professional | | $857.30 | $1,144.38 | $2,351.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.80 / $1,268.55 / $2,024.16
| Professional | | $953.80 | $1,268.55 | $2,024.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.04 / $1,081.05 / $1,843.87
| Professional | | $782.04 | $1,081.05 | $1,843.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.97 / $1,096.86 / $1,328.54
| Professional | | $835.97 | $1,096.86 | $1,328.54 |