- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,812.18 / $2,748.76 / $2,791.99
| Professional | | $1,812.18 | $2,748.76 | $2,791.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.81 / $2,376.62 / $3,556.41
| Professional | | $1,936.81 | $2,376.62 | $3,556.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,186.71 / $2,791.99 / $3,918.71
| Professional | | $2,186.71 | $2,791.99 | $3,918.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.13 / $2,268.75 / $3,530.18
| Professional | | $2,038.13 | $2,268.75 | $3,530.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,812.18 / $2,073.42 / $2,791.99
| Professional | | $1,812.18 | $2,073.42 | $2,791.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.03 / $2,632.08 / $3,176.65
| Professional | | $1,857.03 | $2,632.08 | $3,176.65 |