- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,380.34 / $2,380.34 / $2,592.53
| Professional | | $2,380.34 | $2,380.34 | $2,592.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,881.54 / $3,396.70 / $7,896.93
| Professional | | $2,881.54 | $3,396.70 | $7,896.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.59 / $3,060.96 / $4,976.97
| Professional | | $2,736.59 | $3,060.96 | $4,976.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,343.09 / $3,102.06 / $4,976.97
| Professional | | $2,343.09 | $3,102.06 | $4,976.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,563.02 / $3,125.95 / $9,087.35
| Professional | | $2,563.02 | $3,125.95 | $9,087.35 |