- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.16 / $1,599.01 / $2,843.24
| Professional | | $1,359.16 | $1,599.01 | $2,843.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.68 / $1,465.68 / $1,465.68
| Professional | | $1,465.68 | $1,465.68 | $1,465.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.57 / $1,389.30 / $1,389.30
| Professional | | $1,156.57 | $1,389.30 | $1,389.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.27 / $1,816.02 / $2,666.17
| Professional | | $1,029.27 | $1,816.02 | $2,666.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.09 / $1,507.92 / $2,573.12
| Professional | | $823.09 | $1,507.92 | $2,573.12 |