- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.59 / $1,182.66 / $1,279.79
| Professional | | $867.59 | $1,182.66 | $1,279.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.75 / $1,410.26 / $2,129.83
| Professional | | $1,089.75 | $1,410.26 | $2,129.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.95 / $1,654.90 / $2,364.34
| Professional | | $1,196.95 | $1,654.90 | $2,364.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.65 / $1,549.98 / $2,377.73
| Professional | | $1,339.65 | $1,549.98 | $2,377.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.59 / $1,279.79 / $1,664.84
| Professional | | $867.59 | $1,279.79 | $1,664.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.10 / $1,529.50 / $2,169.94
| Professional | | $1,048.10 | $1,529.50 | $2,169.94 |