- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.27 / $1,030.27 / $2,493.25
| Professional | | $1,030.27 | $1,030.27 | $2,493.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.51 / $1,113.83 / $8,500.00
| Professional | | $1,113.51 | $1,113.83 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.44 / $1,764.56 / $2,784.62
| Professional | | $1,013.44 | $1,764.56 | $2,784.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.86 / $2,269.10 / $2,269.10
| Professional | | $1,097.86 | $2,269.10 | $2,269.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.45 / $1,570.05 / $2,747.27
| Professional | | $870.45 | $1,570.05 | $2,747.27 |