- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.93 / $2,992.92 / $14,460.50
| Professional | | $2,784.93 | $2,992.92 | $14,460.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,073.00 / $3,246.36 / $3,710.60
| Professional | | $3,073.00 | $3,246.36 | $3,710.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,496.13 / $3,732.33 / $7,570.77
| Professional | | $2,496.13 | $3,732.33 | $7,570.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,058.66 / $3,945.67 / $6,622.31
| Professional | | $3,058.66 | $3,945.67 | $6,622.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,333.71 / $3,446.69 / $7,266.26
| Professional | | $2,333.71 | $3,446.69 | $7,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,379.21 / $3,517.46 / $4,223.67
| Professional | | $2,379.21 | $3,517.46 | $4,223.67 |