- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.56 / $1,315.43 / $6,230.73
| Professional | | $1,179.56 | $1,315.43 | $6,230.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.90 / $1,516.96 / $4,223.09
| Professional | | $1,286.90 | $1,516.96 | $4,223.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.17 / $1,824.14 / $2,145.65
| Professional | | $1,085.17 | $1,824.14 | $2,145.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.17 / $1,730.66 / $2,145.65
| Professional | | $1,085.17 | $1,730.66 | $2,145.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.90 / $1,494.08 / $4,852.99
| Professional | | $1,297.90 | $1,494.08 | $4,852.99 |