- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.59 / $2,201.76 / $4,344.13
| Professional | | $2,003.59 | $2,201.76 | $4,344.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,129.61 / $2,356.55 / $2,693.53
| Professional | | $2,129.61 | $2,356.55 | $2,693.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.35 / $2,139.29 / $4,512.28
| Professional | | $1,679.35 | $2,139.29 | $4,512.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.66 / $2,368.00 / $3,924.07
| Professional | | $1,835.66 | $2,368.00 | $3,924.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.88 / $2,057.73 / $3,214.40
| Professional | | $1,544.88 | $2,057.73 | $3,214.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.06 / $1,444.06 / $2,575.23
| Professional | | $1,444.06 | $1,444.06 | $2,575.23 |