- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.66 / $2,672.57 / $3,882.17
| Professional | | $2,115.66 | $2,672.57 | $3,882.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,921.10 / $2,809.67 / $3,211.45
| Professional | | $1,921.10 | $2,809.67 | $3,211.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.12 / $2,470.92 / $5,515.30
| Professional | | $1,900.12 | $2,470.92 | $5,515.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,244.06 / $2,894.84 / $4,797.64
| Professional | | $2,244.06 | $2,894.84 | $4,797.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.76 / $2,292.09 / $4,639.30
| Professional | | $1,730.76 | $2,292.09 | $4,639.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.18 / $1,769.18 / $3,147.40
| Professional | | $1,769.18 | $1,769.18 | $3,147.40 |