- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $8,317.64
| Professional | | $2,951.21 | $3,715.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $6,918.31
| Professional | | $2,884.03 | $4,786.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,570.88 / $7,244.36
| Professional | | $3,311.31 | $4,570.88 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,365.16 / $8,128.31
| Professional | | $3,548.13 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $8,709.64
| Professional | | $3,019.95 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,265.80 / $6,456.54
| Professional | | $2,818.38 | $4,265.80 | $6,456.54 |