- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.77 / $1,426.92 / $1,803.02
| Professional | | $1,212.77 | $1,426.92 | $1,803.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.02 / $1,691.30 / $2,389.73
| Professional | | $1,350.02 | $1,691.30 | $2,389.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.70 / $1,980.36 / $3,285.19
| Professional | | $1,454.70 | $1,980.36 | $3,285.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.62 / $1,875.92 / $2,918.93
| Professional | | $1,473.62 | $1,875.92 | $2,918.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.77 / $1,426.92 / $1,803.02
| Professional | | $1,212.77 | $1,426.92 | $1,803.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.97 / $1,865.83 / $3,026.26
| Professional | | $1,326.97 | $1,865.83 | $3,026.26 |