- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.81 / $1,234.79 / $1,234.79
| Professional | | $1,232.81 | $1,234.79 | $1,234.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.42 / $1,710.91 / $3,728.25
| Professional | | $1,451.42 | $1,710.91 | $3,728.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.08 / $1,664.26 / $2,328.65
| Professional | | $1,249.08 | $1,664.26 | $2,328.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.08 / $1,546.70 / $2,328.65
| Professional | | $1,249.08 | $1,546.70 | $2,328.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.22 / $1,462.58 / $4,251.82
| Professional | | $1,191.22 | $1,462.58 | $4,251.82 |