- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.88 / $1,781.67 / $4,644.10
| Professional | | $1,732.88 | $1,781.67 | $4,644.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.00 / $1,930.89 / $2,207.01
| Professional | | $1,840.00 | $1,930.89 | $2,207.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.18 / $2,147.39 / $4,502.89
| Professional | | $1,512.18 | $2,147.39 | $4,502.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,855.39 / $2,393.44 / $3,889.94
| Professional | | $1,855.39 | $2,393.44 | $3,889.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.05 / $1,946.77 / $3,532.34
| Professional | | $1,389.05 | $1,946.77 | $3,532.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.33 / $2,133.69 / $2,556.75
| Professional | | $1,495.33 | $2,133.69 | $2,556.75 |