- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,966.62 / $3,464.49 / $15,552.10
| Professional | | $2,966.62 | $3,464.49 | $15,552.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,550.00 / $3,621.62 / $4,139.51
| Professional | | $2,550.00 | $3,621.62 | $4,139.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,672.14 / $4,405.80 / $7,806.95
| Professional | | $2,672.14 | $4,405.80 | $7,806.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,052.91 / $4,045.70 / $6,706.69
| Professional | | $3,052.91 | $4,045.70 | $6,706.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.25 / $3,459.30 / $6,252.68
| Professional | | $2,303.25 | $3,459.30 | $6,252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,481.86 / $3,606.63 / $4,397.87
| Professional | | $2,481.86 | $3,606.63 | $4,397.87 |