- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.16 / $1,205.26 / $1,445.92
| Professional | | $546.16 | $1,205.26 | $1,445.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.34 / $742.34 / $742.34
| Professional | | $742.34 | $742.34 | $742.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.41 / $2,087.28 / $2,561.67
| Professional | | $1,992.41 | $2,087.28 | $2,561.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.10 / $1,897.53 / $1,897.53
| Professional | | $1,806.10 | $1,897.53 | $1,897.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.56 / $984.79 / $1,138.52
| Professional | | $771.56 | $984.79 | $1,138.52 |