- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.78 / $1,120.11 / $1,240.55
| Professional | | $890.78 | $1,120.11 | $1,240.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.84 / $1,319.80 / $1,967.29
| Professional | | $1,019.84 | $1,319.80 | $1,967.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.95 / $1,535.81 / $2,277.42
| Professional | | $1,063.95 | $1,535.81 | $2,277.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.83 / $1,486.55 / $2,280.44
| Professional | | $1,284.83 | $1,486.55 | $2,280.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.78 / $1,240.54 / $1,931.35
| Professional | | $890.78 | $1,240.54 | $1,931.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.71 / $1,306.51 / $1,999.20
| Professional | | $941.71 | $1,306.51 | $1,999.20 |