- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.91 / $1,149.92 / $2,637.86
| Professional | | $1,016.91 | $1,149.92 | $2,637.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.45 / $1,526.72 / $4,498.47
| Professional | | $1,257.45 | $1,526.72 | $4,498.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.73 / $1,521.77 / $3,216.45
| Professional | | $1,069.73 | $1,521.77 | $3,216.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.81 / $1,627.70 / $3,216.45
| Professional | | $1,187.81 | $1,627.70 | $3,216.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.81 / $1,583.75 / $4,604.07
| Professional | | $1,187.81 | $1,583.75 | $4,604.07 |