- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.49 / $1,020.49 / $1,145.68
| Professional | | $1,020.49 | $1,020.49 | $1,145.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.42 / $1,058.97 / $1,628.13
| Professional | | $961.42 | $1,058.97 | $1,628.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.25 / $1,190.36 / $1,705.41
| Professional | | $955.25 | $1,190.36 | $1,705.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.39 / $1,140.30 / $1,749.29
| Professional | | $885.39 | $1,140.30 | $1,749.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.49 / $1,020.49 / $1,145.68
| Professional | | $1,020.49 | $1,020.49 | $1,145.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.57 / $1,126.91 / $1,578.29
| Professional | | $985.57 | $1,126.91 | $1,578.29 |