- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.75 / $2,525.27 / $11,120.10
| Professional | | $2,061.75 | $2,525.27 | $11,120.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,331.73 / $2,590.83 / $3,316.26
| Professional | | $2,331.73 | $2,590.83 | $3,316.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,868.70 / $2,791.57 / $5,410.85
| Professional | | $1,868.70 | $2,791.57 | $5,410.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.02 / $2,794.17 / $4,782.43
| Professional | | $2,166.02 | $2,794.17 | $4,782.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.79 / $2,514.98 / $4,548.85
| Professional | | $1,793.79 | $2,514.98 | $4,548.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.69 / $2,490.92 / $3,080.16
| Professional | | $1,724.69 | $2,490.92 | $3,080.16 |