- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.97 / $1,165.22 / $5,798.86
| Professional | | $1,116.97 | $1,165.22 | $5,798.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.73 / $1,264.73 / $1,445.58
| Professional | | $1,264.73 | $1,264.73 | $1,445.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.16 / $1,476.10 / $3,410.52
| Professional | | $1,056.16 | $1,476.10 | $3,410.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.91 / $1,502.78 / $2,403.17
| Professional | | $1,129.91 | $1,502.78 | $2,403.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.74 / $1,351.09 / $2,609.12
| Professional | | $980.74 | $1,351.09 | $2,609.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.30 / $1,299.40 / $1,616.30
| Professional | | $899.30 | $1,299.40 | $1,616.30 |