- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.03 / $1,347.11 / $1,347.11
| Professional | | $1,321.03 | $1,347.11 | $1,347.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.63 / $1,908.00 / $3,998.64
| Professional | | $1,618.63 | $1,908.00 | $3,998.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.70 / $1,930.99 / $2,485.06
| Professional | | $1,225.70 | $1,930.99 | $2,485.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.86 / $1,648.84 / $2,485.06
| Professional | | $1,152.86 | $1,648.84 | $2,485.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.64 / $1,560.83 / $4,537.45
| Professional | | $1,377.64 | $1,560.83 | $4,537.45 |