- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,202.65 / $3,435.87 / $16,450.90
| Professional | | $3,202.65 | $3,435.87 | $16,450.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,553.00 / $3,702.89 / $4,232.39
| Professional | | $3,553.00 | $3,702.89 | $4,232.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,863.66 / $4,300.63 / $8,705.24
| Professional | | $2,863.66 | $4,300.63 | $8,705.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,509.60 / $4,527.38 / $7,566.56
| Professional | | $3,509.60 | $4,527.38 | $7,566.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,661.74 / $3,918.02 / $7,239.01
| Professional | | $2,661.74 | $3,918.02 | $7,239.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,762.85 / $4,036.04 / $4,844.91
| Professional | | $2,762.85 | $4,036.04 | $4,844.91 |