- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.67 / $1,175.81 / $3,151.17
| Professional | | $1,105.67 | $1,175.81 | $3,151.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.96 / $1,243.96 / $1,421.84
| Professional | | $1,243.96 | $1,243.96 | $1,421.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.99 / $1,456.74 / $3,369.40
| Professional | | $1,070.99 | $1,456.74 | $3,369.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.26 / $1,483.30 / $2,372.48
| Professional | | $1,115.26 | $1,483.30 | $2,372.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.79 / $1,283.57 / $2,177.94
| Professional | | $944.79 | $1,283.57 | $2,177.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.38 / $1,282.55 / $1,594.86
| Professional | | $943.38 | $1,282.55 | $1,594.86 |