- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,363.81 / $2,589.41 / $5,184.63
| Professional | | $2,363.81 | $2,589.41 | $5,184.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,499.79 / $2,771.13 / $3,167.41
| Professional | | $2,499.79 | $2,771.13 | $3,167.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,973.25 / $2,647.46 / $5,306.13
| Professional | | $1,973.25 | $2,647.46 | $5,306.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.04 / $2,785.16 / $4,617.32
| Professional | | $2,159.04 | $2,785.16 | $4,617.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.26 / $2,377.21 / $4,296.81
| Professional | | $1,817.26 | $2,377.21 | $4,296.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.04 / $1,806.04 / $3,027.78
| Professional | | $1,806.04 | $1,806.04 | $3,027.78 |