- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.08 / $2,508.23 / $2,583.67
| Professional | | $2,321.08 | $2,508.23 | $2,583.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,641.14 / $2,641.14 / $3,354.25
| Professional | | $2,641.14 | $2,641.14 | $3,354.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,923.51 / $2,640.02 / $5,260.99
| Professional | | $1,923.51 | $2,640.02 | $5,260.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.42 / $2,709.54 / $4,526.62
| Professional | | $2,100.42 | $2,709.54 | $4,526.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.67 / $2,333.96 / $4,522.56
| Professional | | $1,444.67 | $2,333.96 | $4,522.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.88 / $2,032.88 / $2,032.88
| Professional | | $2,032.88 | $2,032.88 | $2,032.88 |