- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,931.52 / $2,072.79 / $9,964.12
| Professional | | $1,931.52 | $2,072.79 | $9,964.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.36 / $2,250.36 / $2,700.00
| Professional | | $2,250.36 | $2,250.36 | $2,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.25 / $2,656.76 / $5,245.74
| Professional | | $1,856.25 | $2,656.76 | $5,245.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.25 / $2,811.98 / $4,526.63
| Professional | | $2,159.25 | $2,811.98 | $4,526.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.88 / $2,369.73 / $4,121.39
| Professional | | $1,700.88 | $2,369.73 | $4,121.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,827.58 / $2,483.14 / $2,974.71
| Professional | | $1,827.58 | $2,483.14 | $2,974.71 |