- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.46 / $2,653.23 / $9,231.53
| Professional | | $2,100.46 | $2,653.23 | $9,231.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,582.48 / $2,798.06 / $3,700.00
| Professional | | $2,582.48 | $2,798.06 | $3,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.92 / $2,625.59 / $5,475.88
| Professional | | $2,036.92 | $2,625.59 | $5,475.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,227.50 / $2,873.48 / $4,764.03
| Professional | | $2,227.50 | $2,873.48 | $4,764.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.87 / $2,445.83 / $4,141.28
| Professional | | $1,825.87 | $2,445.83 | $4,141.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.21 / $1,757.21 / $3,124.50
| Professional | | $1,757.21 | $1,757.21 | $3,124.50 |