- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.16 / $1,440.01 / $1,993.86
| Professional | | $1,174.16 | $1,440.01 | $1,993.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.48 / $2,698.48 / $3,233.08
| Professional | | $2,698.48 | $2,698.48 | $3,233.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.22 / $1,883.09 / $1,936.43
| Professional | | $968.22 | $1,883.09 | $1,936.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.39 / $930.47 / $5,095.42
| Professional | | $775.39 | $930.47 | $5,095.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.16 / $1,329.24 / $1,329.24
| Professional | | $598.16 | $1,329.24 | $1,329.24 |