- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.99 / $1,515.68 / $2,041.72
| Professional | | $1,326.99 | $1,515.68 | $2,041.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.57 / $1,744.47 / $2,585.42
| Professional | | $1,417.57 | $1,744.47 | $2,585.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.44 / $2,041.72 / $2,872.19
| Professional | | $1,584.44 | $2,041.72 | $2,872.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.01 / $1,665.29 / $2,591.19
| Professional | | $1,496.01 | $1,665.29 | $2,591.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.99 / $1,515.68 / $2,041.72
| Professional | | $1,326.99 | $1,515.68 | $2,041.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.61 / $1,934.92 / $2,955.72
| Professional | | $1,367.61 | $1,934.92 | $2,955.72 |