- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.73 / $2,754.06 / $13,307.00
| Professional | | $2,575.73 | $2,754.06 | $13,307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,541.52 / $3,010.51 / $3,441.01
| Professional | | $2,541.52 | $3,010.51 | $3,441.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,339.87 / $3,537.45 / $6,992.52
| Professional | | $2,339.87 | $3,537.45 | $6,992.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,873.28 / $3,706.53 / $6,026.57
| Professional | | $2,873.28 | $3,706.53 | $6,026.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.67 / $3,052.22 / $5,532.43
| Professional | | $2,179.67 | $3,052.22 | $5,532.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.16 / $3,304.27 / $3,953.97
| Professional | | $2,288.16 | $3,304.27 | $3,953.97 |