- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.74 / $1,209.10 / $1,816.81
| Professional | | $735.74 | $1,209.10 | $1,816.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.52 / $1,549.88 / $2,134.62
| Professional | | $983.52 | $1,549.88 | $2,134.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.78 / $1,752.29 / $2,999.81
| Professional | | $1,020.78 | $1,752.29 | $2,999.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.49 / $1,749.38 / $2,916.10
| Professional | | $1,131.49 | $1,749.38 | $2,916.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.74 / $1,209.10 / $1,816.81
| Professional | | $735.74 | $1,209.10 | $1,816.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,438.58 / $2,139.84 / $3,074.23
| Professional | | $1,438.58 | $2,139.84 | $3,074.23 |