- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,253.27 / $2,468.78 / $5,512.69
| Professional | | $2,253.27 | $2,468.78 | $5,512.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,383.80 / $2,557.52 / $3,700.00
| Professional | | $2,383.80 | $2,557.52 | $3,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.09 / $2,419.19 / $5,058.01
| Professional | | $1,881.09 | $2,419.19 | $5,058.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,057.92 / $2,654.73 / $4,402.31
| Professional | | $2,057.92 | $2,654.73 | $4,402.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.97 / $2,281.67 / $4,146.03
| Professional | | $1,743.97 | $2,281.67 | $4,146.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.43 / $1,628.43 / $2,886.17
| Professional | | $1,628.43 | $1,628.43 | $2,886.17 |