- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.18 / $1,287.49 / $1,547.07
| Professional | | $1,210.18 | $1,287.49 | $1,547.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.08 / $1,670.09 / $1,908.92
| Professional | | $1,386.08 | $1,670.09 | $1,908.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.50 / $1,805.05 / $3,853.66
| Professional | | $1,282.50 | $1,805.05 | $3,853.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.75 / $1,739.89 / $2,889.40
| Professional | | $1,348.75 | $1,739.89 | $2,889.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.54 / $1,509.12 / $2,760.08
| Professional | | $1,092.54 | $1,509.12 | $2,760.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.83 / $1,088.83 / $1,895.76
| Professional | | $1,088.83 | $1,088.83 | $1,895.76 |