- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,193.04 / $2,365.58 / $2,640.28
| Professional | | $2,193.04 | $2,365.58 | $2,640.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,280.77 / $2,540.98 / $3,227.06
| Professional | | $2,280.77 | $2,540.98 | $3,227.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.11 / $2,402.21 / $4,976.68
| Professional | | $1,813.11 | $2,402.21 | $4,976.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.83 / $2,551.40 / $4,214.66
| Professional | | $1,977.83 | $2,551.40 | $4,214.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.28 / $2,506.62 / $3,744.43
| Professional | | $1,825.28 | $2,506.62 | $3,744.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.34 / $1,586.34 / $2,779.52
| Professional | | $1,586.34 | $1,586.34 | $2,779.52 |