- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.44 / $2,397.75 / $11,540.60
| Professional | | $2,236.44 | $2,397.75 | $11,540.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,871.22 / $2,871.22 / $3,281.79
| Professional | | $2,871.22 | $2,871.22 | $3,281.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,152.01 / $3,074.88 / $6,072.59
| Professional | | $2,152.01 | $3,074.88 | $6,072.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,498.73 / $3,323.31 / $5,239.14
| Professional | | $2,498.73 | $3,323.31 | $5,239.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.06 / $2,837.77 / $4,782.14
| Professional | | $1,957.06 | $2,837.77 | $4,782.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,122.59 / $2,873.54 / $3,440.67
| Professional | | $2,122.59 | $2,873.54 | $3,440.67 |