- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.72 / $789.57 / $3,775.79
| Professional | | $728.72 | $789.57 | $3,775.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.00 / $851.41 / $973.16
| Professional | | $830.00 | $851.41 | $973.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.22 / $1,003.46 / $1,981.18
| Professional | | $669.22 | $1,003.46 | $1,981.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.78 / $1,057.52 / $1,720.96
| Professional | | $819.78 | $1,057.52 | $1,720.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.21 / $860.68 / $1,542.07
| Professional | | $616.21 | $860.68 | $1,542.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.95 / $942.75 / $1,132.57
| Professional | | $663.95 | $942.75 | $1,132.57 |