- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.71 / $2,392.12 / $5,378.52
| Professional | | $1,768.71 | $2,392.12 | $5,378.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.37 / $2,554.61 / $2,919.92
| Professional | | $2,321.37 | $2,554.61 | $2,919.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.99 / $2,463.06 / $4,934.35
| Professional | | $1,832.99 | $2,463.06 | $4,934.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.02 / $2,587.77 / $4,289.68
| Professional | | $2,006.02 | $2,587.77 | $4,289.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,588.04 / $2,200.53 / $3,998.80
| Professional | | $1,588.04 | $2,200.53 | $3,998.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.15 / $1,684.15 / $2,813.01
| Professional | | $1,684.15 | $1,684.15 | $2,813.01 |