- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,597.39 / $2,911.76 / $7,023.52
| Professional | | $2,597.39 | $2,911.76 | $7,023.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,809.07 / $3,117.33 / $3,975.00
| Professional | | $2,809.07 | $3,117.33 | $3,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.60 / $2,914.41 / $5,969.01
| Professional | | $2,218.60 | $2,914.41 | $5,969.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,428.30 / $3,132.51 / $5,190.91
| Professional | | $2,428.30 | $3,132.51 | $5,190.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,064.58 / $2,694.70 / $4,535.05
| Professional | | $2,064.58 | $2,694.70 | $4,535.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.30 / $2,039.30 / $3,405.02
| Professional | | $2,039.30 | $2,039.30 | $3,405.02 |