- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.56 / $1,882.66 / $2,014.36
| Professional | | $1,857.56 | $1,882.66 | $2,014.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,761.23 / $3,147.80
| Professional | | $2,510.21 | $2,761.23 | $3,147.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,375.43 / $1,980.93 / $7,250.82
| Professional | | $1,375.43 | $1,980.93 | $7,250.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $3,012.25 / $3,765.32
| Professional | | $2,510.21 | $3,012.25 | $3,765.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.49 / $1,380.86 / $2,284.23
| Professional | | $1,104.49 | $1,380.86 | $2,284.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.10 / $1,995.62 / $1,995.62
| Professional | | $1,255.10 | $1,995.62 | $1,995.62 |