- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,861.03 / $1,995.20 / $9,608.51
| Professional | | $1,861.03 | $1,995.20 | $9,608.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.31 / $2,175.31 / $2,775.00
| Professional | | $2,175.31 | $2,175.31 | $2,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.63 / $2,560.27 / $5,054.08
| Professional | | $1,752.63 | $2,560.27 | $5,054.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,080.42 / $2,766.96 / $4,359.95
| Professional | | $2,080.42 | $2,766.96 | $4,359.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,607.94 / $2,360.50 / $4,269.46
| Professional | | $1,607.94 | $2,360.50 | $4,269.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.69 / $2,392.48 / $2,865.02
| Professional | | $1,736.69 | $2,392.48 | $2,865.02 |