- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,473.27 / $2,649.88 / $12,792.90
| Professional | | $2,473.27 | $2,649.88 | $12,792.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,514.48 / $2,899.50 / $3,314.13
| Professional | | $2,514.48 | $2,899.50 | $3,314.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.67 / $3,399.70 / $6,716.04
| Professional | | $2,313.67 | $3,399.70 | $6,716.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,762.66 / $3,563.83 / $5,799.37
| Professional | | $2,762.66 | $3,563.83 | $5,799.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.92 / $3,066.29 / $5,312.16
| Professional | | $2,133.92 | $3,066.29 | $5,312.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,311.36 / $3,177.06 / $3,804.21
| Professional | | $2,311.36 | $3,177.06 | $3,804.21 |