- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.07 / $1,426.67 / $1,605.02
| Professional | | $1,092.07 | $1,426.67 | $1,605.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,375.72 / $1,780.35 / $2,718.96
| Professional | | $1,375.72 | $1,780.35 | $2,718.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.74 / $2,080.81 / $2,934.78
| Professional | | $1,485.74 | $2,080.81 | $2,934.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.22 / $1,978.72 / $3,035.47
| Professional | | $1,710.22 | $1,978.72 | $3,035.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.07 / $1,605.02 / $1,975.98
| Professional | | $1,092.07 | $1,605.02 | $1,975.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.64 / $1,839.95 / $2,706.81
| Professional | | $1,178.64 | $1,839.95 | $2,706.81 |