- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,112.52 / $2,265.96 / $10,920.20
| Professional | | $2,112.52 | $2,265.96 | $10,920.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,473.25 / $2,473.25 / $3,375.00
| Professional | | $2,473.25 | $2,473.25 | $3,375.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.67 / $2,908.51 / $5,736.62
| Professional | | $2,025.67 | $2,908.51 | $5,736.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,364.86 / $3,145.26 / $4,953.00
| Professional | | $2,364.86 | $3,145.26 | $4,953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.07 / $2,529.73 / $4,600.39
| Professional | | $1,842.07 | $2,529.73 | $4,600.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.48 / $2,719.59 / $3,257.00
| Professional | | $2,002.48 | $2,719.59 | $3,257.00 |