- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.61 / $1,676.61 / $7,346.55
| Professional | | $1,401.61 | $1,676.61 | $7,346.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,630.00 / $1,700.19 / $1,943.32
| Professional | | $1,630.00 | $1,700.19 | $1,943.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.96 / $1,963.53 / $3,695.46
| Professional | | $1,378.96 | $1,963.53 | $3,695.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.88 / $1,981.54 / $3,184.59
| Professional | | $1,489.88 | $1,981.54 | $3,184.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.98 / $1,711.80 / $3,342.83
| Professional | | $1,300.98 | $1,711.80 | $3,342.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.29 / $1,713.36 / $2,089.96
| Professional | | $1,196.29 | $1,713.36 | $2,089.96 |