- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.05 / $2,371.44 / $5,898.81
| Professional | | $2,201.05 | $2,371.44 | $5,898.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.50 / $2,412.10 / $2,757.03
| Professional | | $1,992.50 | $2,412.10 | $2,757.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.47 / $2,899.38 / $5,232.78
| Professional | | $1,927.47 | $2,899.38 | $5,232.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.42 / $2,718.58 / $4,507.96
| Professional | | $2,107.42 | $2,718.58 | $4,507.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.85 / $2,565.37 / $4,211.01
| Professional | | $1,847.85 | $2,565.37 | $4,211.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.12 / $2,423.54 / $2,956.20
| Professional | | $1,676.12 | $2,423.54 | $2,956.20 |