- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,322.12 / $2,770.73 / $12,177.70
| Professional | | $2,322.12 | $2,770.73 | $12,177.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,300.00 / $2,833.85 / $3,239.08
| Professional | | $2,300.00 | $2,833.85 | $3,239.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.63 / $3,361.66 / $6,117.53
| Professional | | $2,206.63 | $3,361.66 | $6,117.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,463.58 / $3,178.02 / $5,266.67
| Professional | | $2,463.58 | $3,178.02 | $5,266.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,985.36 / $2,709.99 / $4,882.68
| Professional | | $1,985.36 | $2,709.99 | $4,882.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.75 / $2,833.12 / $3,455.43
| Professional | | $1,937.75 | $2,833.12 | $3,455.43 |