- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.34 / $1,789.83 / $9,332.37
| Professional | | $1,546.34 | $1,789.83 | $9,332.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,971.30 / $1,971.30 / $2,253.19
| Professional | | $1,971.30 | $1,971.30 | $2,253.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.98 / $2,567.27 / $5,569.74
| Professional | | $1,696.98 | $2,567.27 | $5,569.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.23 / $2,462.14 / $3,977.02
| Professional | | $1,851.23 | $2,462.14 | $3,977.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.67 / $2,052.48 / $3,888.89
| Professional | | $1,558.67 | $2,052.48 | $3,888.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.28 / $2,128.91 / $2,620.90
| Professional | | $1,434.28 | $2,128.91 | $2,620.90 |