- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,272.86 / $2,954.37 / $6,171.16
| Professional | | $2,272.86 | $2,954.37 | $6,171.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.85 / $2,760.33 / $3,650.00
| Professional | | $2,736.85 | $2,760.33 | $3,650.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,264.40 / $2,973.04 / $6,090.25
| Professional | | $2,264.40 | $2,973.04 | $6,090.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,478.59 / $3,197.38 / $5,298.27
| Professional | | $2,478.59 | $3,197.38 | $5,298.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,106.86 / $2,904.68 / $4,983.66
| Professional | | $2,106.86 | $2,904.68 | $4,983.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,080.65 / $2,080.65 / $3,475.38
| Professional | | $2,080.65 | $2,080.65 | $3,475.38 |