- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,629.21 / $3,944.58 / $4,377.20
| Professional | | $3,629.21 | $3,944.58 | $4,377.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,823.73 / $4,154.26 / $5,275.91
| Professional | | $3,823.73 | $4,154.26 | $5,275.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,020.88 / $4,030.39 / $8,130.43
| Professional | | $3,020.88 | $4,030.39 | $8,130.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,306.37 / $4,265.22 / $7,065.91
| Professional | | $3,306.37 | $4,265.22 | $7,065.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,836.61 / $3,681.59 / $6,190.17
| Professional | | $2,836.61 | $3,681.59 | $6,190.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,624.39 / $2,624.39 / $4,636.42
| Professional | | $2,624.39 | $2,624.39 | $4,636.42 |