- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.76 / $2,639.09 / $12,725.80
| Professional | | $2,465.76 | $2,639.09 | $12,725.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.52 / $2,421.38 / $2,767.63
| Professional | | $2,318.52 | $2,421.38 | $2,767.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,037.73 / $3,157.96 / $6,695.22
| Professional | | $2,037.73 | $3,157.96 | $6,695.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.00 / $3,551.37 / $5,771.66
| Professional | | $2,753.00 | $3,551.37 | $5,771.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,837.20 / $2,912.40 / $5,280.58
| Professional | | $1,837.20 | $2,912.40 | $5,280.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,966.17 / $3,165.95 / $3,789.64
| Professional | | $1,966.17 | $3,165.95 | $3,789.64 |