- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,595.75 / $2,817.34 / $3,136.58
| Professional | | $2,595.75 | $2,817.34 | $3,136.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,684.17 / $2,982.66 / $3,787.98
| Professional | | $2,684.17 | $2,982.66 | $3,787.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,132.78 / $2,830.90 / $5,881.82
| Professional | | $2,132.78 | $2,830.90 | $5,881.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,326.40 / $3,001.06 / $4,960.09
| Professional | | $2,326.40 | $3,001.06 | $4,960.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,158.83 / $3,302.47 / $5,073.16
| Professional | | $2,158.83 | $3,302.47 | $5,073.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,876.67 / $1,876.67 / $3,269.48
| Professional | | $1,876.67 | $1,876.67 | $3,269.48 |