- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.19 / $1,169.38 / $1,266.30
| Professional | | $1,151.19 | $1,169.38 | $1,266.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.30 / $1,524.85 / $2,202.61
| Professional | | $1,284.30 | $1,524.85 | $2,202.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.77 / $1,643.65 / $2,490.60
| Professional | | $1,405.77 | $1,643.65 | $2,490.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.50 / $1,649.18 / $2,529.92
| Professional | | $1,280.50 | $1,649.18 | $2,529.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.19 / $1,169.38 / $1,266.30
| Professional | | $1,151.19 | $1,169.38 | $1,266.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.00 / $1,704.21 / $2,516.00
| Professional | | $1,233.00 | $1,704.21 | $2,516.00 |