- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.32 / $1,076.82 / $1,524.39
| Professional | | $893.32 | $1,076.82 | $1,524.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.95 / $1,310.07 / $1,925.72
| Professional | | $1,058.95 | $1,310.07 | $1,925.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.52 / $1,524.39 / $2,145.50
| Professional | | $1,253.52 | $1,524.39 | $2,145.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.49 / $1,250.60 / $1,945.95
| Professional | | $1,123.49 | $1,250.60 | $1,945.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.32 / $1,524.39 / $1,825.82
| Professional | | $893.32 | $1,524.39 | $1,825.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.79 / $1,499.02 / $1,938.39
| Professional | | $1,100.79 | $1,499.02 | $1,938.39 |