- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.12 / $2,503.94 / $4,946.16
| Professional | | $2,287.12 | $2,503.94 | $4,946.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.62 / $2,658.70 / $3,038.89
| Professional | | $2,417.62 | $2,658.70 | $3,038.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.16 / $2,547.73 / $5,131.96
| Professional | | $1,908.16 | $2,547.73 | $5,131.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,087.51 / $2,692.89 / $4,467.55
| Professional | | $2,087.51 | $2,692.89 | $4,467.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.94 / $2,380.37 / $4,152.57
| Professional | | $1,723.94 | $2,380.37 | $4,152.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.94 / $1,652.94 / $2,927.70
| Professional | | $1,652.94 | $1,652.94 | $2,927.70 |