- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.93 / $1,071.39 / $1,307.48
| Professional | | $936.93 | $1,071.39 | $1,307.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.95 / $1,401.46 / $1,969.89
| Professional | | $1,082.95 | $1,401.46 | $1,969.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.46 / $1,516.62 / $2,216.07
| Professional | | $991.46 | $1,516.62 | $2,216.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.77 / $1,484.16 / $2,276.79
| Professional | | $1,282.77 | $1,484.16 | $2,276.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.93 / $1,130.50 / $1,581.24
| Professional | | $936.93 | $1,130.50 | $1,581.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.61 / $1,413.16 / $2,030.35
| Professional | | $919.61 | $1,413.16 | $2,030.35 |