- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.40 / $2,388.63 / $5,400.96
| Professional | | $2,194.40 | $2,388.63 | $5,400.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.75 / $2,542.14 / $2,905.67
| Professional | | $2,321.75 | $2,542.14 | $2,905.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.47 / $2,407.67 / $4,928.64
| Professional | | $1,832.47 | $2,407.67 | $4,928.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,004.59 / $2,585.92 / $4,287.60
| Professional | | $2,004.59 | $2,585.92 | $4,287.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.77 / $2,282.96 / $4,585.03
| Professional | | $1,698.77 | $2,282.96 | $4,585.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.12 / $1,586.12 / $2,811.47
| Professional | | $1,586.12 | $1,586.12 | $2,811.47 |