- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.82 / $1,209.60 / $2,481.78
| Professional | | $1,103.82 | $1,209.60 | $2,481.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.00 / $1,085.30 / $1,313.21
| Professional | | $1,070.00 | $1,085.30 | $1,313.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.47 / $1,235.69 / $2,486.54
| Professional | | $926.47 | $1,235.69 | $2,486.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.88 / $1,310.49 / $2,147.85
| Professional | | $1,015.88 | $1,310.49 | $2,147.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.54 / $1,206.34 / $1,899.06
| Professional | | $866.54 | $1,206.34 | $1,899.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.87 / $856.87 / $1,423.37
| Professional | | $856.87 | $856.87 | $1,423.37 |