- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.31 / $5,590.77 / $6,559.47
| Professional | | $1,032.31 | $5,590.77 | $6,559.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,872.93 / $3,950.34 / $5,728.65
| Professional | | $2,872.93 | $3,950.34 | $5,728.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,726.00 / $3,918.45 / $7,874.10
| Professional | | $2,726.00 | $3,918.45 | $7,874.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,213.75 / $5,872.00 / $8,700.90
| Professional | | $4,213.75 | $5,872.00 | $8,700.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,495.60 / $6,025.50 / $8,834.00
| Professional | | $2,495.60 | $6,025.50 | $8,834.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,703.36 / $5,586.91 / $8,147.39
| Professional | | $3,703.36 | $5,586.91 | $8,147.39 |