- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,765.89 / $2,365.32 / $2,846.95
| Professional | | $1,765.89 | $2,365.32 | $2,846.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.01 / $2,302.21 / $3,296.27
| Professional | | $1,981.01 | $2,302.21 | $3,296.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.86 / $3,183.43 / $4,585.18
| Professional | | $2,167.86 | $3,183.43 | $4,585.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.30 / $2,674.87 / $4,740.12
| Professional | | $2,179.30 | $2,674.87 | $4,740.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,765.89 / $2,368.26 / $2,846.95
| Professional | | $1,765.89 | $2,368.26 | $2,846.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.67 / $3,390.99 / $4,272.42
| Professional | | $2,128.67 | $3,390.99 | $4,272.42 |