- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,865.69 / $2,310.00 / $9,294.00
| Professional | | $1,865.69 | $2,310.00 | $9,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,404.27 / $2,404.27 / $2,895.31
| Professional | | $2,404.27 | $2,404.27 | $2,895.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,258.69 / $2,969.85 / $8,696.19
| Professional | | $2,258.69 | $2,969.85 | $8,696.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,151.94 / $2,504.08 / $8,696.19
| Professional | | $2,151.94 | $2,504.08 | $8,696.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,360.21 / $3,082.03 / $10,673.60
| Professional | | $2,360.21 | $3,082.03 | $10,673.60 |