- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.77 / $1,211.50 / $6,032.42
| Professional | | $1,162.77 | $1,211.50 | $6,032.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.85 / $1,315.85 / $1,520.00
| Professional | | $1,315.85 | $1,315.85 | $1,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.38 / $1,533.00 / $3,549.45
| Professional | | $1,117.38 | $1,533.00 | $3,549.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.83 / $1,563.87 / $2,499.63
| Professional | | $1,175.83 | $1,563.87 | $2,499.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.90 / $1,472.45 / $2,633.09
| Professional | | $1,019.90 | $1,472.45 | $2,633.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.25 / $1,352.22 / $1,681.94
| Professional | | $906.25 | $1,352.22 | $1,681.94 |