- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,446.42 / $2,659.44 / $5,026.07
| Professional | | $2,446.42 | $2,659.44 | $5,026.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,516.01 / $2,524.06 / $2,885.00
| Professional | | $2,516.01 | $2,524.06 | $2,885.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.35 / $2,735.35 / $5,478.98
| Professional | | $2,039.35 | $2,735.35 | $5,478.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.06 / $2,887.10 / $4,743.46
| Professional | | $2,238.06 | $2,887.10 | $4,743.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.72 / $2,569.54 / $4,500.84
| Professional | | $1,920.72 | $2,569.54 | $4,500.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,816.33 / $1,816.33 / $3,135.08
| Professional | | $1,816.33 | $1,816.33 | $3,135.08 |