- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.40 / $2,706.10 / $3,857.77
| Professional | | $2,494.40 | $2,706.10 | $3,857.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,605.28 / $2,904.76 / $3,320.15
| Professional | | $2,605.28 | $2,904.76 | $3,320.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.48 / $2,775.97 / $5,561.99
| Professional | | $2,016.48 | $2,775.97 | $5,561.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.98 / $2,854.74 / $4,814.33
| Professional | | $2,212.98 | $2,854.74 | $4,814.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.65 / $2,664.30 / $4,591.88
| Professional | | $1,928.65 | $2,664.30 | $4,591.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.98 / $1,833.98 / $3,099.92
| Professional | | $1,833.98 | $1,833.98 | $3,099.92 |