- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.79 / $1,557.66 / $2,455.34
| Professional | | $1,214.79 | $1,557.66 | $2,455.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,244.30 / $3,718.62 / $5,391.57
| Professional | | $2,244.30 | $3,718.62 | $5,391.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,489.07 / $4,090.10 / $6,589.77
| Professional | | $2,489.07 | $4,090.10 | $6,589.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,301.94 / $3,677.68 / $6,009.87
| Professional | | $2,301.94 | $3,677.68 | $6,009.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.79 / $3,299.94 / $9,077.52
| Professional | | $1,817.79 | $3,299.94 | $9,077.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.17 / $3,177.13 / $6,065.71
| Professional | | $1,735.17 | $3,177.13 | $6,065.71 |