- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,109.73 / $2,261.54 / $10,905.00
| Professional | | $2,109.73 | $2,261.54 | $10,905.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,208.78 / $2,468.67 / $2,821.69
| Professional | | $2,208.78 | $2,468.67 | $2,821.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.92 / $2,981.85 / $5,728.74
| Professional | | $2,031.92 | $2,981.85 | $5,728.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,356.40 / $3,039.76 / $4,947.08
| Professional | | $2,356.40 | $3,039.76 | $4,947.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,894.44 / $2,603.73 / $4,514.97
| Professional | | $1,894.44 | $2,603.73 | $4,514.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,065.52 / $2,709.86 / $3,245.13
| Professional | | $2,065.52 | $2,709.86 | $3,245.13 |