- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.34 / $3,445.52 / $3,445.52
| Professional | | $2,398.34 | $3,445.52 | $3,445.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,383.69 / $2,890.03 / $4,368.45
| Professional | | $2,383.69 | $2,890.03 | $4,368.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,841.41 / $3,643.24 / $8,008.13
| Professional | | $2,841.41 | $3,643.24 | $8,008.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,478.42 / $2,758.85 / $4,292.77
| Professional | | $2,478.42 | $2,758.85 | $4,292.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.34 / $3,445.52 / $3,445.52
| Professional | | $2,398.34 | $3,445.52 | $3,445.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,042.95 / $3,606.46 / $4,301.14
| Professional | | $3,042.95 | $3,606.46 | $4,301.14 |