- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,607.81 / $2,834.33 / $5,142.18
| Professional | | $2,607.81 | $2,834.33 | $5,142.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,676.81 / $2,686.28 / $3,070.42
| Professional | | $2,676.81 | $2,686.28 | $3,070.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,173.23 / $2,914.45 / $5,837.25
| Professional | | $2,173.23 | $2,914.45 | $5,837.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.19 / $3,076.90 / $5,056.47
| Professional | | $2,385.19 | $3,076.90 | $5,056.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.73 / $2,706.07 / $4,357.51
| Professional | | $2,051.73 | $2,706.07 | $4,357.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.47 / $1,915.47 / $3,341.01
| Professional | | $1,915.47 | $1,915.47 | $3,341.01 |