- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.27 / $1,058.98 / $1,436.37
| Professional | | $854.27 | $1,058.98 | $1,436.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.86 / $1,278.29 / $1,900.34
| Professional | | $1,002.86 | $1,278.29 | $1,900.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.21 / $1,583.69 / $2,627.17
| Professional | | $1,079.21 | $1,583.69 | $2,627.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.21 / $1,491.75 / $2,321.16
| Professional | | $1,088.21 | $1,491.75 | $2,321.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.27 / $1,058.98 / $1,436.37
| Professional | | $854.27 | $1,058.98 | $1,436.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.43 / $1,524.91 / $2,414.05
| Professional | | $1,104.43 | $1,524.91 | $2,414.05 |