- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,440.80 / $2,482.78 / $7,623.33
| Professional | | $2,440.80 | $2,482.78 | $7,623.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,881.42 / $3,417.39 / $3,906.08
| Professional | | $2,881.42 | $3,417.39 | $3,906.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,491.81 / $3,748.07 / $7,546.79
| Professional | | $2,491.81 | $3,748.07 | $7,546.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.28 / $3,938.73 / $6,500.27
| Professional | | $3,053.28 | $3,938.73 | $6,500.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,402.13 / $3,247.98 / $5,870.09
| Professional | | $2,402.13 | $3,247.98 | $5,870.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.46 / $3,511.27 / $4,330.50
| Professional | | $2,544.46 | $3,511.27 | $4,330.50 |