- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,180.28 / $4,952.81 / $5,116.16
| Professional | | $3,180.28 | $4,952.81 | $5,116.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,525.23 / $4,310.22 / $6,398.55
| Professional | | $3,525.23 | $4,310.22 | $6,398.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,107.39 / $4,527.14 / $7,119.05
| Professional | | $4,107.39 | $4,527.14 | $7,119.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,696.33 / $4,114.58 / $6,402.29
| Professional | | $3,696.33 | $4,114.58 | $6,402.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,180.28 / $3,916.67 / $5,116.16
| Professional | | $3,180.28 | $3,916.67 | $5,116.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,746.06 / $4,746.07 / $6,421.41
| Professional | | $3,746.06 | $4,746.07 | $6,421.41 |