- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.39 / $2,366.62 / $2,886.16
| Professional | | $1,757.39 | $2,366.62 | $2,886.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,351.21 / $3,042.75 / $4,267.88
| Professional | | $2,351.21 | $3,042.75 | $4,267.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,276.25 / $3,312.07 / $4,857.64
| Professional | | $2,276.25 | $3,312.07 | $4,857.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,785.65 / $3,223.00 / $4,944.25
| Professional | | $2,785.65 | $3,223.00 | $4,944.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.39 / $2,236.06 / $2,886.16
| Professional | | $1,757.39 | $2,236.06 | $2,886.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.19 / $2,785.65 / $3,555.04
| Professional | | $2,030.19 | $2,785.65 | $3,555.04 |