- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.88 / $1,587.76 / $3,065.95
| Professional | | $1,446.88 | $1,587.76 | $3,065.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.40 / $1,623.38 / $1,855.52
| Professional | | $1,397.40 | $1,623.38 | $1,855.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.56 / $1,624.00 / $3,260.15
| Professional | | $1,211.56 | $1,624.00 | $3,260.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.31 / $1,708.36 / $2,835.25
| Professional | | $1,324.31 | $1,708.36 | $2,835.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.04 / $1,444.05 / $2,619.94
| Professional | | $1,100.04 | $1,444.05 | $2,619.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.93 / $1,092.93 / $1,857.82
| Professional | | $1,092.93 | $1,092.93 | $1,857.82 |