- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.92 / $1,094.72 / $1,464.35
| Professional | | $1,047.92 | $1,094.72 | $1,464.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.07 / $1,149.18 / $1,585.86
| Professional | | $832.07 | $1,149.18 | $1,585.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.44 / $1,265.33 / $1,581.66
| Professional | | $1,054.44 | $1,265.33 | $1,581.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.64 / $1,427.52 / $2,431.69
| Professional | | $1,086.64 | $1,427.52 | $2,431.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.56 / $1,339.14 / $2,316.11
| Professional | | $1,001.56 | $1,339.14 | $2,316.11 |