- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.61 / $1,164.88 / $5,795.08
| Professional | | $1,116.61 | $1,164.88 | $5,795.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.71 / $1,377.13 / $1,574.06
| Professional | | $1,266.71 | $1,377.13 | $1,574.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.81 / $1,550.62 / $3,514.80
| Professional | | $1,054.81 | $1,550.62 | $3,514.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.23 / $1,501.88 / $2,401.66
| Professional | | $1,129.23 | $1,501.88 | $2,401.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.57 / $1,340.04 / $2,376.81
| Professional | | $955.57 | $1,340.04 | $2,376.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.42 / $1,298.60 / $1,615.32
| Professional | | $877.42 | $1,298.60 | $1,615.32 |