- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,426.21 / $3,989.34 / $17,981.50
| Professional | | $3,426.21 | $3,989.34 | $17,981.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,768.21 / $4,186.89 / $5,359.23
| Professional | | $3,768.21 | $4,186.89 | $5,359.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,963.18 / $4,981.20 / $9,023.14
| Professional | | $2,963.18 | $4,981.20 | $9,023.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,542.99 / $4,686.10 / $7,766.88
| Professional | | $3,542.99 | $4,686.10 | $7,766.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,809.68 / $4,217.14 / $7,219.23
| Professional | | $2,809.68 | $4,217.14 | $7,219.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.09 / $4,177.54 / $5,095.17
| Professional | | $2,863.09 | $4,177.54 | $5,095.17 |