- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,555.08 / $3,226.63 / $3,582.20
| Professional | | $2,555.08 | $3,226.63 | $3,582.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.27 / $2,987.47 / $3,414.67
| Professional | | $2,059.27 | $2,987.47 | $3,414.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.38 / $2,941.42 / $6,649.21
| Professional | | $2,016.38 | $2,941.42 | $6,649.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,671.34 / $3,446.03 / $5,713.98
| Professional | | $2,671.34 | $3,446.03 | $5,713.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.80 / $2,595.52 / $4,974.32
| Professional | | $1,372.80 | $2,595.52 | $4,974.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,130.63 / $2,130.63 / $3,755.54
| Professional | | $2,130.63 | $2,130.63 | $3,755.54 |