- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.59 / $974.90 / $1,113.09
| Professional | | $957.59 | $974.90 | $1,113.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.97 / $1,136.68 / $1,704.73
| Professional | | $945.97 | $1,136.68 | $1,704.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.32 / $1,415.24 / $2,138.32
| Professional | | $1,064.32 | $1,415.24 | $2,138.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.76 / $1,266.84 / $2,285.33
| Professional | | $1,052.76 | $1,266.84 | $2,285.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.59 / $974.90 / $1,113.09
| Professional | | $957.59 | $974.90 | $1,113.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.40 / $1,486.61 / $1,838.04
| Professional | | $1,013.40 | $1,486.61 | $1,838.04 |