- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.15 / $1,349.05 / $6,725.69
| Professional | | $1,295.15 | $1,349.05 | $6,725.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.28 / $1,496.34 / $1,710.32
| Professional | | $1,467.28 | $1,496.34 | $1,710.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.83 / $1,706.49 / $3,954.78
| Professional | | $1,246.83 | $1,706.49 | $3,954.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.07 / $1,687.41 / $2,786.69
| Professional | | $1,308.07 | $1,687.41 | $2,786.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.80 / $1,512.54 / $2,569.89
| Professional | | $1,115.80 | $1,512.54 | $2,569.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.81 / $1,504.28 / $1,871.21
| Professional | | $1,020.81 | $1,504.28 | $1,871.21 |