- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,951.21 / $5,128.61
| Professional | | $1,584.89 | $2,951.21 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,311.31 / $5,128.61
| Professional | | $2,089.30 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,162.28 / $5,128.61
| Professional | | $1,778.28 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $4,365.16
| Professional | | $2,754.23 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,548.13 / $6,760.83
| Professional | | $2,630.27 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,388.44 / $4,466.84
| Professional | | $1,995.26 | $3,388.44 | $4,466.84 |