- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,727.93 / $3,018.81 / $4,916.29
| Professional | | $2,727.93 | $3,018.81 | $4,916.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,912.69 / $3,196.06 / $3,653.10
| Professional | | $2,912.69 | $3,196.06 | $3,653.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,163.78 / $2,770.01 / $6,183.95
| Professional | | $2,163.78 | $2,770.01 | $6,183.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,515.67 / $3,245.23 / $5,382.39
| Professional | | $2,515.67 | $3,245.23 | $5,382.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.38 / $2,680.13 / $5,370.02
| Professional | | $1,724.38 | $2,680.13 | $5,370.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.29 / $1,991.29 / $3,527.89
| Professional | | $1,991.29 | $1,991.29 | $3,527.89 |