- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,125.15 / $2,311.39 / $2,577.23
| Professional | | $2,125.15 | $2,311.39 | $2,577.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.15 / $2,046.75 / $2,599.37
| Professional | | $2,031.15 | $2,046.75 | $2,599.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,771.92 / $2,248.05 / $4,760.39
| Professional | | $1,771.92 | $2,248.05 | $4,760.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.35 / $2,508.21 / $4,122.46
| Professional | | $1,944.35 | $2,508.21 | $4,122.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.63 / $2,213.11 / $3,658.84
| Professional | | $1,669.63 | $2,213.11 | $3,658.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.00 / $2,236.00 / $2,723.73
| Professional | | $2,236.00 | $2,236.00 | $2,723.73 |