- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.16 / $2,183.16 / $10,484.70
| Professional | | $2,031.16 | $2,183.16 | $10,484.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.94 / $2,368.32 / $2,706.99
| Professional | | $1,794.94 | $2,368.32 | $2,706.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.86 / $2,795.66 / $5,517.16
| Professional | | $1,852.86 | $2,795.66 | $5,517.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.19 / $2,932.43 / $4,764.35
| Professional | | $2,273.19 | $2,932.43 | $4,764.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.56 / $2,386.89 / $4,230.56
| Professional | | $1,698.56 | $2,386.89 | $4,230.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,829.26 / $2,614.17 / $3,132.84
| Professional | | $1,829.26 | $2,614.17 | $3,132.84 |