- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.00 / $2,187.11 / $11,503.80
| Professional | | $1,896.00 | $2,187.11 | $11,503.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,414.23 / $2,427.92 / $2,775.12
| Professional | | $2,414.23 | $2,427.92 | $2,775.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,101.71 / $3,146.39 / $6,816.64
| Professional | | $2,101.71 | $3,146.39 | $6,816.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,261.10 / $3,007.26 / $4,875.55
| Professional | | $2,261.10 | $3,007.26 | $4,875.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,834.50 / $2,658.77 / $4,467.13
| Professional | | $1,834.50 | $2,658.77 | $4,467.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.72 / $2,600.27 / $3,201.50
| Professional | | $1,766.72 | $2,600.27 | $3,201.50 |