- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,924.17 / $2,477.71 / $6,640.28
| Professional | | $1,924.17 | $2,477.71 | $6,640.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.60 / $2,684.70 / $3,068.61
| Professional | | $2,240.60 | $2,684.70 | $3,068.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.45 / $2,320.15 / $5,126.02
| Professional | | $1,908.45 | $2,320.15 | $5,126.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.67 / $2,685.37 / $4,443.10
| Professional | | $2,081.67 | $2,685.37 | $4,443.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.73 / $2,187.33 / $3,883.64
| Professional | | $1,646.73 | $2,187.33 | $3,883.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.52 / $1,641.52 / $2,924.49
| Professional | | $1,641.52 | $1,641.52 | $2,924.49 |