- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.09 / $1,340.90 / $2,583.67
| Professional | | $1,230.09 | $1,340.90 | $2,583.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.72 / $1,250.72 / $1,740.00
| Professional | | $1,250.72 | $1,250.72 | $1,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.49 / $1,325.10 / $2,758.90
| Professional | | $1,028.49 | $1,325.10 | $2,758.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.41 / $1,455.65 / $2,388.28
| Professional | | $1,128.41 | $1,455.65 | $2,388.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.61 / $1,250.63 / $2,117.57
| Professional | | $964.61 | $1,250.63 | $2,117.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.45 / $901.45 / $1,580.73
| Professional | | $901.45 | $901.45 | $1,580.73 |