- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.23 / $901.66 / $5,544.93
| Professional | | $885.23 | $901.66 | $5,544.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.59 / $1,286.34 / $1,470.29
| Professional | | $1,241.59 | $1,286.34 | $1,470.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.79 / $1,416.30 / $2,731.04
| Professional | | $973.79 | $1,416.30 | $2,731.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.00 / $1,461.67 / $2,363.06
| Professional | | $1,099.00 | $1,461.67 | $2,363.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.21 / $1,354.18 / $2,308.89
| Professional | | $931.21 | $1,354.18 | $2,308.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.92 / $1,263.84 / $1,560.17
| Professional | | $1,006.92 | $1,263.84 | $1,560.17 |