- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,306.52 / $1,881.63 / $3,772.03
| Professional | | $1,306.52 | $1,881.63 | $3,772.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.50 / $1,739.50 / $2,205.32
| Professional | | $1,739.50 | $1,739.50 | $2,205.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.95 / $1,890.39 / $3,889.67
| Professional | | $1,444.95 | $1,890.39 | $3,889.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.03 / $2,038.24 / $3,385.17
| Professional | | $1,580.03 | $2,038.24 | $3,385.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.77 / $1,736.84 / $3,782.79
| Professional | | $1,262.77 | $1,736.84 | $3,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.58 / $1,310.58 / $2,216.25
| Professional | | $1,310.58 | $1,310.58 | $2,216.25 |