- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.38 / $1,720.47 / $1,931.56
| Professional | | $1,560.38 | $1,720.47 | $1,931.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.57 / $1,953.13 / $2,931.89
| Professional | | $1,657.57 | $1,953.13 | $2,931.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $699.00 / $1,636.73
| Facility | | $699.00 | $699.00 | $1,636.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.40 / $2,165.96 / $3,098.16
| Professional | | $1,469.40 | $2,165.96 | $3,098.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.44 / $2,048.35 / $3,205.32
| Professional | | $1,590.44 | $2,048.35 | $3,205.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.38 / $1,720.47 / $3,308.18
| Professional | | $1,560.38 | $1,720.47 | $3,308.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.78 / $2,120.15 / $3,020.09
| Professional | | $1,445.78 | $2,120.15 | $3,020.09 |