- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.03 / $1,063.10 / $1,581.07
| Professional | | $924.03 | $1,063.10 | $1,581.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.30 / $1,386.39 / $1,941.90
| Professional | | $1,071.30 | $1,386.39 | $1,941.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.58 / $1,536.65 / $2,197.28
| Professional | | $1,026.58 | $1,536.65 | $2,197.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.04 / $1,463.65 / $2,245.32
| Professional | | $1,265.04 | $1,463.65 | $2,245.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.61 / $976.50 / $1,290.22
| Professional | | $852.61 | $976.50 | $1,290.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.56 / $1,394.97 / $2,200.79
| Professional | | $980.56 | $1,394.97 | $2,200.79 |