- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.24 / $1,414.81 / $1,748.47
| Professional | | $1,133.24 | $1,414.81 | $1,748.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.82 / $1,331.46 / $1,565.12
| Professional | | $1,280.82 | $1,331.46 | $1,565.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.75 / $1,915.50 / $3,626.09
| Professional | | $1,177.75 | $1,915.50 | $3,626.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.80 / $1,977.31 / $2,624.87
| Professional | | $1,532.80 | $1,977.31 | $2,624.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.46 / $1,786.18 / $3,208.21
| Professional | | $1,254.46 | $1,786.18 | $3,208.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.58 / $1,762.72 / $2,194.73
| Professional | | $1,217.58 | $1,762.72 | $2,194.73 |