- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.15 / $2,163.27 / $2,868.22
| Professional | | $1,880.15 | $2,163.27 | $2,868.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,990.47 / $2,449.59 / $3,653.33
| Professional | | $1,990.47 | $2,449.59 | $3,653.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,352.42 / $2,868.22 / $3,995.77
| Professional | | $2,352.42 | $2,868.22 | $3,995.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.71 / $2,338.41 / $3,638.57
| Professional | | $2,100.71 | $2,338.41 | $3,638.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.00 / $2,163.27 / $2,868.22
| Professional | | $1,708.00 | $2,163.27 | $2,868.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.80 / $2,714.89 / $3,276.60
| Professional | | $2,001.80 | $2,714.89 | $3,276.60 |