- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.90 / $2,533.54 / $4,616.59
| Professional | | $2,282.90 | $2,533.54 | $4,616.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.87 / $2,679.93 / $3,063.16
| Professional | | $2,442.87 | $2,679.93 | $3,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.89 / $2,324.66 / $5,193.66
| Professional | | $1,898.89 | $2,324.66 | $5,193.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,111.21 / $2,723.46 / $4,514.20
| Professional | | $2,111.21 | $2,723.46 | $4,514.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.66 / $2,296.42 / $3,951.57
| Professional | | $1,698.66 | $2,296.42 | $3,951.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.13 / $1,676.13 / $2,960.30
| Professional | | $1,676.13 | $1,676.13 | $2,960.30 |