- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.17 / $1,439.10 / $2,266.57
| Professional | | $1,111.17 | $1,439.10 | $2,266.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.76 / $3,464.81 / $5,036.12
| Professional | | $2,103.76 | $3,464.81 | $5,036.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.86 / $3,766.19 / $6,215.35
| Professional | | $2,332.86 | $3,766.19 | $6,215.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,155.59 / $3,423.83 / $5,667.46
| Professional | | $2,155.59 | $3,423.83 | $5,667.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.62 / $3,104.65 / $8,373.92
| Professional | | $1,683.62 | $3,104.65 | $8,373.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,678.98 / $2,953.49 / $5,737.07
| Professional | | $1,678.98 | $2,953.49 | $5,737.07 |