- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.93 / $1,902.33 / $4,430.06
| Professional | | $1,741.93 | $1,902.33 | $4,430.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.60 / $2,006.46 / $2,700.00
| Professional | | $1,856.60 | $2,006.46 | $2,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.33 / $1,888.18 / $3,934.14
| Professional | | $1,464.33 | $1,888.18 | $3,934.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,600.68 / $2,064.88 / $3,420.72
| Professional | | $1,600.68 | $2,064.88 | $3,420.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.84 / $1,742.53 / $2,960.02
| Professional | | $1,283.84 | $1,742.53 | $2,960.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.58 / $1,256.58 / $2,245.44
| Professional | | $1,256.58 | $1,256.58 | $2,245.44 |