- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,249.48 / $2,469.96 / $4,993.59
| Professional | | $2,249.48 | $2,469.96 | $4,993.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,386.01 / $2,584.25 / $3,096.59
| Professional | | $2,386.01 | $2,584.25 | $3,096.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,882.22 / $2,462.46 / $5,061.13
| Professional | | $1,882.22 | $2,462.46 | $5,061.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.36 / $2,655.28 / $4,400.92
| Professional | | $2,058.36 | $2,655.28 | $4,400.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.59 / $2,256.87 / $3,821.33
| Professional | | $1,642.59 | $2,256.87 | $3,821.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.00 / $1,622.00 / $2,887.13
| Professional | | $1,622.00 | $1,622.00 | $2,887.13 |