- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.30 / $1,017.77 / $1,223.63
| Professional | | $811.30 | $1,017.77 | $1,223.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.06 / $1,318.79 / $1,869.47
| Professional | | $1,019.06 | $1,318.79 | $1,869.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.72 / $1,468.35 / $2,095.39
| Professional | | $996.72 | $1,468.35 | $2,095.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.94 / $1,412.63 / $2,167.05
| Professional | | $1,220.94 | $1,412.63 | $2,167.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.30 / $1,112.38 / $1,223.63
| Professional | | $811.30 | $1,112.38 | $1,223.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.68 / $1,279.28 / $1,940.08
| Professional | | $927.68 | $1,279.28 | $1,940.08 |