- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,276.76 / $2,494.91 / $4,987.18
| Professional | | $2,276.76 | $2,494.91 | $4,987.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,408.02 / $2,669.05 / $3,050.72
| Professional | | $2,408.02 | $2,669.05 | $3,050.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.13 / $2,549.60 / $5,110.64
| Professional | | $1,900.13 | $2,549.60 | $5,110.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.89 / $2,681.77 / $4,448.25
| Professional | | $2,078.89 | $2,681.77 | $4,448.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.42 / $2,297.42 / $4,437.28
| Professional | | $1,777.42 | $2,297.42 | $4,437.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.34 / $1,738.34 / $2,915.46
| Professional | | $1,738.34 | $1,738.34 | $2,915.46 |