- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.20 / $1,379.60 / $2,765.86
| Professional | | $1,141.20 | $1,379.60 | $2,765.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.95 / $1,899.42 / $2,517.03
| Professional | | $1,225.95 | $1,899.42 | $2,517.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $226.36 / $1,886.34
| Professional | | $32.34 | $226.36 | $1,886.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.60 / $1,973.93 / $2,931.66
| Professional | | $1,277.60 | $1,973.93 | $2,931.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.52 / $2,064.23 / $3,253.77
| Professional | | $1,543.52 | $2,064.23 | $3,253.77 |