- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,958.16 / $3,229.06 / $4,552.85
| Professional | | $2,958.16 | $3,229.06 | $4,552.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,393.56 / $3,419.16 / $3,908.11
| Professional | | $2,393.56 | $3,419.16 | $3,908.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,342.90 / $2,972.68 / $6,609.76
| Professional | | $2,342.90 | $2,972.68 | $6,609.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,699.74 / $3,482.66 / $5,754.49
| Professional | | $2,699.74 | $3,482.66 | $5,754.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,202.08 / $2,854.89 / $5,777.26
| Professional | | $2,202.08 | $2,854.89 | $5,777.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.64 / $2,119.64 / $3,790.11
| Professional | | $2,119.64 | $2,119.64 | $3,790.11 |