- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.91 / $617.38 / $1,035.83
| Professional | | $508.91 | $617.38 | $1,035.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.51 / $771.38 / $1,080.74
| Professional | | $475.51 | $771.38 | $1,080.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.59 / $1,234.11 / $1,603.82
| Professional | | $952.59 | $1,234.11 | $1,603.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.51 / $1,213.14 / $4,283.07
| Professional | | $970.51 | $1,213.14 | $4,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.24 / $1,249.39 / $1,655.49
| Professional | | $846.24 | $1,249.39 | $1,655.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.35 / $1,182.81 / $1,487.92
| Professional | | $972.35 | $1,182.81 | $1,487.92 |