- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,235.94 / $7,585.78
| Professional | | $2,630.27 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,168.69 / $6,165.95
| Professional | | $2,511.89 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,073.80 / $6,309.57
| Professional | | $3,162.28 | $4,073.80 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $7,079.46
| Professional | | $3,162.28 | $3,801.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,890.45 / $7,943.28
| Professional | | $2,691.53 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $5,623.41
| Professional | | $2,454.71 | $3,715.35 | $5,623.41 |