- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.77 / $1,334.77 / $1,421.11
| Professional | | $1,334.77 | $1,334.77 | $1,421.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.93 / $1,735.27 / $2,506.54
| Professional | | $1,458.93 | $1,735.27 | $2,506.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.20 / $1,871.23 / $2,834.73
| Professional | | $1,601.20 | $1,871.23 | $2,834.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.39 / $1,875.71 / $2,877.43
| Professional | | $1,456.39 | $1,875.71 | $2,877.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.77 / $1,334.77 / $1,421.11
| Professional | | $1,334.77 | $1,334.77 | $1,421.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,536.68 / $1,829.44 / $2,595.30
| Professional | | $1,536.68 | $1,829.44 | $2,595.30 |