- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.66 / $2,236.33 / $7,910.00
| Professional | | $2,105.66 | $2,236.33 | $7,910.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.96 / $2,429.96 / $2,777.44
| Professional | | $2,429.96 | $2,429.96 | $2,777.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,976.57 / $2,866.01 / $5,659.47
| Professional | | $1,976.57 | $2,866.01 | $5,659.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,330.17 / $3,056.75 / $4,883.13
| Professional | | $2,330.17 | $3,056.75 | $4,883.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.25 / $2,556.69 / $4,946.07
| Professional | | $1,805.25 | $2,556.69 | $4,946.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.14 / $2,679.70 / $3,209.13
| Professional | | $1,957.14 | $2,679.70 | $3,209.13 |