- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.25 / $1,777.21 / $8,564.70
| Professional | | $1,602.25 | $1,777.21 | $8,564.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.00 / $1,932.82 / $2,209.21
| Professional | | $1,720.00 | $1,932.82 | $2,209.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.07 / $2,170.50 / $4,195.43
| Professional | | $1,563.07 | $2,170.50 | $4,195.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.13 / $2,238.81 / $3,697.44
| Professional | | $1,684.13 | $2,238.81 | $3,697.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.96 / $1,940.70 / $3,270.42
| Professional | | $1,392.96 | $1,940.70 | $3,270.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.49 / $1,936.75 / $2,395.55
| Professional | | $1,490.49 | $1,936.75 | $2,395.55 |