- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.01 / $1,526.94 / $3,267.41
| Professional | | $1,213.01 | $1,526.94 | $3,267.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,493.03 / $1,650.55 / $1,886.57
| Professional | | $1,493.03 | $1,650.55 | $1,886.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.95 / $1,572.89 / $3,160.45
| Professional | | $1,176.95 | $1,572.89 | $3,160.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.65 / $1,658.49 / $2,744.89
| Professional | | $1,285.65 | $1,658.49 | $2,744.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.85 / $1,442.40 / $2,697.32
| Professional | | $1,031.85 | $1,442.40 | $2,697.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.75 / $1,051.75 / $1,803.99
| Professional | | $1,051.75 | $1,051.75 | $1,803.99 |