- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,949.31 / $3,203.79 / $5,674.81
| Professional | | $2,949.31 | $3,203.79 | $5,674.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,948.59 / $3,408.00 / $3,895.34
| Professional | | $2,948.59 | $3,408.00 | $3,895.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,447.48 / $3,005.63 / $6,594.74
| Professional | | $2,447.48 | $3,005.63 | $6,594.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.48 / $3,439.76 / $5,703.13
| Professional | | $2,666.48 | $3,439.76 | $5,703.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.40 / $2,953.35 / $5,000.60
| Professional | | $2,157.40 | $2,953.35 | $5,000.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.14 / $2,119.14 / $3,748.73
| Professional | | $2,119.14 | $2,119.14 | $3,748.73 |