- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,316.62 / $2,500.19 / $6,978.00
| Professional | | $2,316.62 | $2,500.19 | $6,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,720.78 / $2,720.78 / $3,109.86
| Professional | | $2,720.78 | $2,720.78 | $3,109.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.44 / $3,262.22 / $6,334.31
| Professional | | $2,247.44 | $3,262.22 | $6,334.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,606.33 / $3,466.42 / $5,463.10
| Professional | | $2,606.33 | $3,466.42 | $5,463.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.58 / $2,896.82 / $5,212.31
| Professional | | $2,076.58 | $2,896.82 | $5,212.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.73 / $2,997.28 / $3,589.15
| Professional | | $2,248.73 | $2,997.28 | $3,589.15 |