- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,290.87
| Professional | | $1,096.48 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,019.95 / $5,011.87
| Professional | | $1,949.84 | $3,019.95 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $6,165.95
| Professional | | $2,344.23 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,630.78 / $5,888.44
| Professional | | $2,454.71 | $3,630.78 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,090.30 / $8,317.64
| Professional | | $1,479.11 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,511.89 / $4,677.35
| Professional | | $1,318.26 | $2,511.89 | $4,677.35 |