- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.76 / $1,414.26 / $1,537.65
| Professional | | $1,167.76 | $1,414.26 | $1,537.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,699.11 / $3,024.40 / $3,791.09
| Professional | | $2,699.11 | $3,024.40 | $3,791.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.15 / $2,989.39 / $3,907.46
| Professional | | $1,737.15 | $2,989.39 | $3,907.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,613.49 / $3,042.43 / $8,768.71
| Professional | | $1,613.49 | $3,042.43 | $8,768.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,573.15 / $2,873.41 / $3,460.93
| Professional | | $1,573.15 | $2,873.41 | $3,460.93 |