- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.10 / $1,112.76 / $1,344.40
| Professional | | $889.10 | $1,112.76 | $1,344.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.71 / $1,442.57 / $2,051.23
| Professional | | $1,114.71 | $1,442.57 | $2,051.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.17 / $1,589.75 / $2,291.79
| Professional | | $1,007.17 | $1,589.75 | $2,291.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.65 / $1,549.98 / $2,377.73
| Professional | | $1,339.65 | $1,549.98 | $2,377.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.10 / $1,134.57 / $1,344.40
| Professional | | $889.10 | $1,134.57 | $1,344.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.19 / $1,449.81 / $2,622.12
| Professional | | $914.19 | $1,449.81 | $2,622.12 |