- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,040.96 / $3,317.10 / $9,796.00
| Professional | | $3,040.96 | $3,317.10 | $9,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,123.56 / $3,552.45 / $4,060.46
| Professional | | $3,123.56 | $3,552.45 | $4,060.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,533.21 / $3,128.38 / $6,829.44
| Professional | | $2,533.21 | $3,128.38 | $6,829.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,760.12 / $3,560.55 / $5,902.49
| Professional | | $2,760.12 | $3,560.55 | $5,902.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,249.82 / $3,059.56 / $5,577.88
| Professional | | $2,249.82 | $3,059.56 | $5,577.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,221.42 / $2,221.42 / $3,880.17
| Professional | | $2,221.42 | $2,221.42 | $3,880.17 |