- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.32 / $3,165.88 / $3,250.26
| Professional | | $1,996.32 | $3,165.88 | $3,250.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.96 / $2,764.38 / $4,112.95
| Professional | | $2,250.96 | $2,764.38 | $4,112.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,410.81 / $3,250.26 / $4,544.16
| Professional | | $2,410.81 | $3,250.26 | $4,544.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,370.66 / $2,638.90 / $4,106.13
| Professional | | $2,370.66 | $2,638.90 | $4,106.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.32 / $2,288.54 / $3,250.26
| Professional | | $1,996.32 | $2,288.54 | $3,250.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.15 / $3,246.20 / $4,115.18
| Professional | | $2,293.15 | $3,246.20 | $4,115.18 |