- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.32 / $2,222.03 / $3,036.24
| Professional | | $1,819.32 | $2,222.03 | $3,036.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.23 / $2,583.88 / $3,829.19
| Professional | | $2,100.23 | $2,583.88 | $3,829.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.16 / $3,036.24 / $4,245.07
| Professional | | $2,241.16 | $3,036.24 | $4,245.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.88 / $2,466.60 / $3,838.03
| Professional | | $2,215.88 | $2,466.60 | $3,838.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.32 / $2,979.07 / $3,596.17
| Professional | | $1,819.32 | $2,979.07 | $3,596.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.09 / $2,852.88 / $3,443.13
| Professional | | $2,011.09 | $2,852.88 | $3,443.13 |