- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,779.01 / $2,377.79 / $2,725.90
| Professional | | $1,779.01 | $2,377.79 | $2,725.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,395.17 / $2,653.29 / $3,032.71
| Professional | | $2,395.17 | $2,653.29 | $3,032.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.75 / $2,459.76 / $5,080.49
| Professional | | $1,889.75 | $2,459.76 | $5,080.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,066.71 / $2,666.06 / $4,418.66
| Professional | | $2,066.71 | $2,666.06 | $4,418.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.05 / $2,273.44 / $4,096.70
| Professional | | $1,763.05 | $2,273.44 | $4,096.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,629.16 / $1,629.16 / $2,898.78
| Professional | | $1,629.16 | $1,629.16 | $2,898.78 |