- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,451.94 / $3,761.08 / $5,463.37
| Professional | | $3,451.94 | $3,761.08 | $5,463.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,300.00 / $4,020.50 / $4,595.43
| Professional | | $3,300.00 | $4,020.50 | $4,595.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,807.98 / $3,446.57 / $7,745.43
| Professional | | $2,807.98 | $3,446.57 | $7,745.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,130.11 / $4,037.84 / $6,690.45
| Professional | | $3,130.11 | $4,037.84 | $6,690.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,572.17 / $3,476.18 / $5,885.87
| Professional | | $2,572.17 | $3,476.18 | $5,885.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,502.79 / $2,502.79 / $4,400.31
| Professional | | $2,502.79 | $2,502.79 | $4,400.31 |