- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,864.33 / $3,109.94 / $3,456.00
| Professional | | $2,864.33 | $3,109.94 | $3,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,003.15 / $3,340.45 / $3,818.14
| Professional | | $3,003.15 | $3,340.45 | $3,818.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.44 / $3,095.95 / $6,396.23
| Professional | | $2,374.44 | $3,095.95 | $6,396.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,601.21 / $3,355.57 / $5,549.56
| Professional | | $2,601.21 | $3,355.57 | $5,549.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.37 / $2,862.54 / $5,222.59
| Professional | | $2,231.37 | $2,862.54 | $5,222.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.89 / $2,277.89 / $3,646.46
| Professional | | $2,277.89 | $2,277.89 | $3,646.46 |