- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,685.39 / $1,777.69 / $4,764.20
| Professional | | $1,685.39 | $1,777.69 | $4,764.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.32 / $1,906.11 / $2,178.67
| Professional | | $1,887.32 | $1,906.11 | $2,178.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.09 / $2,208.89 / $5,087.54
| Professional | | $1,601.09 | $2,208.89 | $5,087.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.35 / $2,240.19 / $3,609.80
| Professional | | $1,684.35 | $2,240.19 | $3,609.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.69 / $2,031.08 / $3,955.05
| Professional | | $1,460.69 | $2,031.08 | $3,955.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.52 / $1,937.00 / $2,409.71
| Professional | | $1,321.52 | $1,937.00 | $2,409.71 |