- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,200.38 / $3,427.23 / $16,598.80
| Professional | | $3,200.38 | $3,427.23 | $16,598.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,733.61 / $3,733.61 / $4,267.52
| Professional | | $3,733.61 | $3,733.61 | $4,267.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,948.86 / $4,357.43 / $8,695.16
| Professional | | $2,948.86 | $4,357.43 | $8,695.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,527.26 / $4,550.17 / $7,563.37
| Professional | | $3,527.26 | $4,550.17 | $7,563.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.55 / $3,771.01 / $6,840.18
| Professional | | $2,698.55 | $3,771.01 | $6,840.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,942.22 / $4,056.35 / $4,863.00
| Professional | | $2,942.22 | $4,056.35 | $4,863.00 |