- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,757.44 / $4,077.09 / $4,671.06
| Professional | | $3,757.44 | $4,077.09 | $4,671.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,701.00 / $3,701.00 / $3,701.00
| Professional | | $3,701.00 | $3,701.00 | $3,701.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.84 / $5,663.88 / $12,693.21
| Professional | | $3,801.84 | $5,663.88 | $12,693.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,325.97 / $5,580.51 / $8,878.94
| Professional | | $4,325.97 | $5,580.51 | $8,878.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,325.80 / $4,500.24 / $7,583.69
| Professional | | $3,325.80 | $4,500.24 | $7,583.69 |