- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,795.18 / $2,712.97 / $2,736.72
| Professional | | $1,795.18 | $2,712.97 | $2,736.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.75 / $2,345.54 / $3,454.78
| Professional | | $1,899.75 | $2,345.54 | $3,454.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,252.15 / $2,736.72 / $3,845.57
| Professional | | $2,252.15 | $2,736.72 | $3,845.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.47 / $2,239.07 / $3,483.99
| Professional | | $2,011.47 | $2,239.07 | $3,483.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.28 / $2,736.71 / $3,264.49
| Professional | | $1,914.28 | $2,736.71 | $3,264.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,948.35 / $2,584.60 / $3,119.34
| Professional | | $1,948.35 | $2,584.60 | $3,119.34 |