- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.57 / $2,529.17 / $4,993.85
| Professional | | $2,307.57 | $2,529.17 | $4,993.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,439.67 / $2,645.63 / $3,175.00
| Professional | | $2,439.67 | $2,645.63 | $3,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.01 / $2,453.42 / $5,181.80
| Professional | | $1,813.01 | $2,453.42 | $5,181.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.77 / $2,719.02 / $4,507.88
| Professional | | $2,107.77 | $2,719.02 | $4,507.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.26 / $2,209.81 / $3,925.53
| Professional | | $1,519.26 | $2,209.81 | $3,925.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.62 / $1,667.62 / $2,956.01
| Professional | | $1,667.62 | $1,667.62 | $2,956.01 |