- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.76 / $1,486.49 / $2,317.08
| Professional | | $1,167.76 | $1,486.49 | $2,317.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.59 / $3,550.24 / $5,107.68
| Professional | | $2,166.59 | $3,550.24 | $5,107.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.42 / $3,930.03 / $6,288.72
| Professional | | $2,415.42 | $3,930.03 | $6,288.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.94 / $3,540.51 / $5,734.37
| Professional | | $2,217.94 | $3,540.51 | $5,734.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.47 / $3,182.02 / $8,768.71
| Professional | | $1,730.47 | $3,182.02 | $8,768.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.81 / $3,084.95 / $5,771.15
| Professional | | $1,651.81 | $3,084.95 | $5,771.15 |