- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.29 / $2,646.64 / $7,046.95
| Professional | | $2,417.29 | $2,646.64 | $7,046.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,555.71 / $2,795.56 / $3,350.00
| Professional | | $2,555.71 | $2,795.56 | $3,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.15 / $2,489.98 / $5,424.32
| Professional | | $2,017.15 | $2,489.98 | $5,424.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.08 / $2,847.13 / $4,721.39
| Professional | | $2,207.08 | $2,847.13 | $4,721.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.22 / $2,354.08 / $4,113.29
| Professional | | $1,768.22 | $2,354.08 | $4,113.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.97 / $1,746.97 / $3,095.17
| Professional | | $1,746.97 | $1,746.97 | $3,095.17 |