- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.73 / $2,710.38 / $7,180.68
| Professional | | $2,435.73 | $2,710.38 | $7,180.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.00 / $2,506.39 / $2,864.80
| Professional | | $1,820.00 | $2,506.39 | $2,864.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,894.98 / $2,379.41 / $5,567.47
| Professional | | $1,894.98 | $2,379.41 | $5,567.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,253.96 / $2,907.62 / $4,818.50
| Professional | | $2,253.96 | $2,907.62 | $4,818.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.29 / $2,333.41 / $4,822.31
| Professional | | $1,334.29 | $2,333.41 | $4,822.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.97 / $1,740.97 / $3,158.16
| Professional | | $1,740.97 | $1,740.97 | $3,158.16 |