- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,229.71 / $2,327.19 / $3,281.37
| Professional | | $2,229.71 | $2,327.19 | $3,281.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.76 / $2,524.17 / $3,230.95
| Professional | | $2,271.76 | $2,524.17 | $3,230.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.40 / $2,719.74 / $5,273.08
| Professional | | $1,842.40 | $2,719.74 | $5,273.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.29 / $2,722.27 / $4,662.29
| Professional | | $2,110.29 | $2,722.27 | $4,662.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.82 / $2,362.48 / $4,129.47
| Professional | | $1,680.82 | $2,362.48 | $4,129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.37 / $2,426.83 / $3,000.80
| Professional | | $1,676.37 | $2,426.83 | $3,000.80 |