- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,715.35 / $5,248.07
| Professional | | $1,905.46 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $4,786.30
| Professional | | $2,344.23 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,019.95 / $5,495.41
| Professional | | $2,041.74 | $3,019.95 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,467.37 / $4,897.79
| Professional | | $2,884.03 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,388.44 / $5,370.32
| Professional | | $2,089.30 | $3,388.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $4,897.79
| Professional | | $2,137.96 | $3,019.95 | $4,897.79 |