- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.79 / $2,706.29 / $11,972.60
| Professional | | $2,273.79 | $2,706.29 | $11,972.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.00 / $2,796.44 / $3,196.32
| Professional | | $2,480.00 | $2,796.44 | $3,196.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,108.96 / $3,305.93 / $5,985.62
| Professional | | $2,108.96 | $3,305.93 | $5,985.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.15 / $3,105.22 / $5,150.42
| Professional | | $2,407.15 | $3,105.22 | $5,150.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.63 / $2,691.89 / $5,155.64
| Professional | | $1,945.63 | $2,691.89 | $5,155.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,896.79 / $2,768.22 / $3,375.63
| Professional | | $1,896.79 | $2,768.22 | $3,375.63 |