- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.62 / $1,329.73 / $2,100.25
| Professional | | $985.62 | $1,329.73 | $2,100.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.57 / $1,573.12 / $1,944.42
| Professional | | $1,157.57 | $1,573.12 | $1,944.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,610.22 / $1,756.60 / $2,362.76
| Professional | | $1,610.22 | $1,756.60 | $2,362.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,407.71 / $1,770.99
| Professional | | $32.34 | $1,407.71 | $1,770.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,689.94 / $1,988.17 / $2,362.76
| Professional | | $1,689.94 | $1,988.17 | $2,362.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.99 / $1,622.88 / $2,295.21
| Professional | | $1,158.99 | $1,622.88 | $2,295.21 |