- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.82 / $1,590.28 / $2,037.29
| Professional | | $1,275.82 | $1,590.28 | $2,037.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.33 / $1,587.29 / $2,295.44
| Professional | | $1,387.33 | $1,587.29 | $2,295.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.51 / $2,304.07 / $3,341.53
| Professional | | $1,555.51 | $2,304.07 | $3,341.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.25 / $1,930.33 / $3,426.14
| Professional | | $1,515.25 | $1,930.33 | $3,426.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.02 / $1,590.28 / $2,037.29
| Professional | | $1,271.02 | $1,590.28 | $2,037.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.69 / $2,298.23 / $3,085.66
| Professional | | $1,373.69 | $2,298.23 | $3,085.66 |