- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,310.20 / $4,142.13 / $10,781.21
| Professional | | $3,310.20 | $4,142.13 | $10,781.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,009.52 / $4,483.57 / $5,124.72
| Professional | | $4,009.52 | $4,483.57 | $5,124.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,183.64 / $4,112.84 / $8,585.07
| Professional | | $3,183.64 | $4,112.84 | $8,585.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,470.00 / $4,476.30 / $7,196.21
| Professional | | $3,470.00 | $4,476.30 | $7,196.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,976.58 / $3,880.96 / $7,529.06
| Professional | | $2,976.58 | $3,880.96 | $7,529.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,026.34 / $3,026.34 / $4,877.78
| Professional | | $3,026.34 | $3,026.34 | $4,877.78 |