- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.48 / $1,406.92 / $9,083.46
| Professional | | $1,379.48 | $1,406.92 | $9,083.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,783.30 / $2,041.64 / $2,333.60
| Professional | | $1,783.30 | $2,041.64 | $2,333.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.30 / $2,234.16 / $4,263.43
| Professional | | $1,515.30 | $2,234.16 | $4,263.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.86 / $2,213.46 / $3,690.05
| Professional | | $1,715.86 | $2,213.46 | $3,690.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.70 / $1,955.59 / $3,529.22
| Professional | | $1,448.70 | $1,955.59 | $3,529.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.71 / $1,973.24 / $2,435.60
| Professional | | $1,534.71 | $1,973.24 | $2,435.60 |