- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.19 / $2,085.58 / $9,152.59
| Professional | | $1,743.19 | $2,085.58 | $9,152.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.77 / $2,155.91 / $2,464.21
| Professional | | $2,051.77 | $2,155.91 | $2,464.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.68 / $2,541.73 / $4,594.83
| Professional | | $1,694.68 | $2,541.73 | $4,594.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.45 / $2,389.66 / $3,962.00
| Professional | | $1,852.45 | $2,389.66 | $3,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.57 / $2,174.10 / $4,504.92
| Professional | | $1,621.57 | $2,174.10 | $4,504.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.37 / $2,130.32 / $2,598.71
| Professional | | $1,458.37 | $2,130.32 | $2,598.71 |