- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.03 / $2,233.03 / $10,429.60
| Professional | | $2,081.03 | $2,233.03 | $10,429.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,021.45 / $2,246.05 / $2,874.94
| Professional | | $2,021.45 | $2,246.05 | $2,874.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.20 / $2,685.34 / $6,593.66
| Professional | | $1,844.20 | $2,685.34 | $6,593.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,142.27 / $2,792.27 / $4,584.37
| Professional | | $2,142.27 | $2,792.27 | $4,584.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.42 / $2,480.52 / $4,444.27
| Professional | | $1,674.42 | $2,480.52 | $4,444.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,551.30 / $2,489.23 / $3,036.96
| Professional | | $1,551.30 | $2,489.23 | $3,036.96 |