- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,389.63 / $2,451.03 / $6,404.20
| Professional | | $2,389.63 | $2,451.03 | $6,404.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.75 / $2,666.75 / $3,048.09
| Professional | | $2,666.75 | $2,666.75 | $3,048.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,202.92 / $3,143.15 / $6,212.79
| Professional | | $2,202.92 | $3,143.15 | $6,212.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,554.71 / $3,397.76 / $5,358.52
| Professional | | $2,554.71 | $3,397.76 | $5,358.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.30 / $2,807.03 / $4,894.29
| Professional | | $2,011.30 | $2,807.03 | $4,894.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,183.44 / $2,937.92 / $3,517.71
| Professional | | $2,183.44 | $2,937.92 | $3,517.71 |