- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.31 / $1,258.31 / $1,901.27
| Professional | | $1,258.31 | $1,258.31 | $1,901.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.21 / $1,636.08 / $2,398.44
| Professional | | $1,321.21 | $1,636.08 | $2,398.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.60 / $1,901.27 / $2,678.27
| Professional | | $1,563.60 | $1,901.27 | $2,678.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.07 / $1,561.83 / $2,430.21
| Professional | | $1,403.07 | $1,561.83 | $2,430.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.31 / $1,532.88 / $1,901.27
| Professional | | $1,258.31 | $1,532.88 | $1,901.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.75 / $1,792.36 / $2,442.98
| Professional | | $1,337.75 | $1,792.36 | $2,442.98 |