- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,258.93
| Professional | | $588.84 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $2,630.27
| Professional | | $1,071.52 | $1,621.81 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $3,311.31
| Professional | | $1,318.26 | $2,137.96 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,162.28
| Professional | | $1,318.26 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $4,677.35
| Professional | | $741.31 | $1,548.82 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,288.25 / $2,454.71
| Professional | | $676.08 | $1,288.25 | $2,454.71 |