- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,601.14 / $2,839.50 / $6,445.18
| Professional | | $2,601.14 | $2,839.50 | $6,445.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,737.55 / $3,012.54 / $3,975.00
| Professional | | $2,737.55 | $3,012.54 | $3,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,162.06 / $2,814.82 / $5,822.42
| Professional | | $2,162.06 | $2,814.82 | $5,822.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.94 / $3,053.37 / $5,058.74
| Professional | | $2,366.94 | $3,053.37 | $5,058.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.67 / $2,631.03 / $4,770.93
| Professional | | $1,944.67 | $2,631.03 | $4,770.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,994.10 / $1,994.10 / $3,318.73
| Professional | | $1,994.10 | $1,994.10 | $3,318.73 |