- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.41 / $1,358.93 / $3,641.93
| Professional | | $1,276.41 | $1,358.93 | $3,641.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.34 / $1,437.34 / $1,642.88
| Professional | | $1,437.34 | $1,437.34 | $1,642.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.82 / $1,687.05 / $3,897.54
| Professional | | $1,208.82 | $1,687.05 | $3,897.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.75 / $1,716.70 / $2,740.54
| Professional | | $1,290.75 | $1,716.70 | $2,740.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.83 / $1,460.89 / $2,514.81
| Professional | | $1,093.83 | $1,460.89 | $2,514.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.10 / $1,484.36 / $1,845.45
| Professional | | $996.10 | $1,484.36 | $1,845.45 |