- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,482.30 / $2,684.87 / $6,881.46
| Professional | | $2,482.30 | $2,684.87 | $6,881.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,845.50 / $3,252.41
| Professional | | $2,318.00 | $2,845.50 | $3,252.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,204.92 / $3,205.71 / $6,756.16
| Professional | | $2,204.92 | $3,205.71 | $6,756.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,695.94 / $3,477.76 / $5,918.33
| Professional | | $2,695.94 | $3,477.76 | $5,918.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.07 / $2,813.15 / $5,476.78
| Professional | | $1,856.07 | $2,813.15 | $5,476.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.33 / $3,100.33 / $3,735.81
| Professional | | $2,014.33 | $3,100.33 | $3,735.81 |