- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,327.98 / $2,529.42 / $4,601.93
| Professional | | $2,327.98 | $2,529.42 | $4,601.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,340.00 / $2,400.02 / $2,743.21
| Professional | | $2,340.00 | $2,400.02 | $2,743.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.76 / $2,677.38 / $5,210.75
| Professional | | $1,939.76 | $2,677.38 | $5,210.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.65 / $2,745.96 / $4,515.05
| Professional | | $2,128.65 | $2,745.96 | $4,515.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.75 / $2,523.65 / $4,316.03
| Professional | | $1,823.75 | $2,523.65 | $4,316.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,940.81 / $1,940.81 / $2,981.87
| Professional | | $1,940.81 | $1,940.81 | $2,981.87 |