- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.47 / $2,005.36 / $2,032.46
| Professional | | $1,761.47 | $2,005.36 | $2,032.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.96 / $2,493.15 / $2,842.19
| Professional | | $2,167.96 | $2,493.15 | $2,842.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.27 / $1,436.27 / $1,436.27
| Professional | | $1,436.27 | $1,436.27 | $1,436.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.95 / $3,116.44 / $4,064.93
| Professional | | $2,709.95 | $3,116.44 | $4,064.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,246.58 / $2,466.00
| Professional | | $1,138.18 | $1,246.58 | $2,466.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.98 / $1,354.98 / $1,354.98
| Professional | | $1,354.98 | $1,354.98 | $1,354.98 |