- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,727.66 / $2,963.49 / $5,604.35
| Professional | | $2,727.66 | $2,963.49 | $5,604.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,802.58 / $2,956.76 / $3,379.57
| Professional | | $2,802.58 | $2,956.76 | $3,379.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,272.14 / $3,038.52 / $6,104.65
| Professional | | $2,272.14 | $3,038.52 | $6,104.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.85 / $3,217.07 / $5,287.47
| Professional | | $2,493.85 | $3,217.07 | $5,287.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.17 / $2,992.97 / $5,385.94
| Professional | | $2,140.17 | $2,992.97 | $5,385.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,088.16 / $2,088.16 / $3,493.20
| Professional | | $2,088.16 | $2,088.16 | $3,493.20 |