- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,564.30 / $2,787.89 / $5,562.37
| Professional | | $2,564.30 | $2,787.89 | $5,562.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,706.48 / $2,966.53 / $3,390.73
| Professional | | $2,706.48 | $2,966.53 | $3,390.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,135.69 / $2,813.17 / $5,751.10
| Professional | | $2,135.69 | $2,813.17 | $5,751.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,337.01 / $3,014.74 / $5,001.34
| Professional | | $2,337.01 | $3,014.74 | $5,001.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.53 / $2,561.13 / $4,696.52
| Professional | | $1,905.53 | $2,561.13 | $4,696.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.45 / $1,956.45 / $3,277.29
| Professional | | $1,956.45 | $1,956.45 | $3,277.29 |