- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.66 / $1,470.13 / $1,470.13
| Professional | | $1,144.66 | $1,470.13 | $1,470.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.65 / $1,258.69 / $1,866.81
| Professional | | $1,023.65 | $1,258.69 | $1,866.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.54 / $1,470.13 / $2,056.25
| Professional | | $1,239.54 | $1,470.13 | $2,056.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.42 / $1,201.56 / $1,869.63
| Professional | | $1,079.42 | $1,201.56 | $1,869.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.66 / $1,470.13 / $1,470.13
| Professional | | $1,144.66 | $1,470.13 | $1,470.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.36 / $1,431.22 / $1,864.52
| Professional | | $1,006.36 | $1,431.22 | $1,864.52 |