- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,503.48 / $1,651.25 / $3,097.95
| Professional | | $1,503.48 | $1,651.25 | $3,097.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.79 / $1,614.53 / $2,100.00
| Professional | | $1,450.79 | $1,614.53 | $2,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.78 / $1,683.15 / $3,386.12
| Professional | | $1,257.78 | $1,683.15 | $3,386.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.70 / $1,773.36 / $2,945.30
| Professional | | $1,374.70 | $1,773.36 | $2,945.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.15 / $1,552.09 / $2,725.28
| Professional | | $1,159.15 | $1,552.09 | $2,725.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.01 / $1,137.01 / $1,928.66
| Professional | | $1,137.01 | $1,137.01 | $1,928.66 |