- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.73 / $2,297.53 / $2,366.66
| Professional | | $2,007.73 | $2,297.53 | $2,366.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,692.42 / $2,692.42 / $3,419.37
| Professional | | $2,692.42 | $2,692.42 | $3,419.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.13 / $2,282.63 / $4,548.76
| Professional | | $1,773.13 | $2,282.63 | $4,548.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,897.12 / $2,447.28 / $3,996.71
| Professional | | $1,897.12 | $2,447.28 | $3,996.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.66 / $2,009.52 / $3,476.93
| Professional | | $1,281.66 | $2,009.52 | $3,476.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,562.88 / $1,562.88 / $1,562.88
| Professional | | $1,562.88 | $1,562.88 | $1,562.88 |