- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,136.55 / $2,218.56 / $11,084.60
| Professional | | $2,136.55 | $2,218.56 | $11,084.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,412.41 / $2,417.44 / $2,763.15
| Professional | | $2,412.41 | $2,417.44 | $2,763.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.40 / $2,802.20 / $6,511.19
| Professional | | $2,045.40 | $2,802.20 | $6,511.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,153.60 / $2,864.29 / $4,587.35
| Professional | | $2,153.60 | $2,864.29 | $4,587.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,809.34 / $2,472.00 / $4,237.64
| Professional | | $1,809.34 | $2,472.00 | $4,237.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.48 / $2,476.64 / $3,081.59
| Professional | | $1,684.48 | $2,476.64 | $3,081.59 |