- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.47 / $2,338.15 / $10,289.20
| Professional | | $1,908.47 | $2,338.15 | $10,289.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.00 / $2,397.34 / $2,740.15
| Professional | | $1,580.00 | $2,397.34 | $2,740.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,731.16 / $2,586.88 / $5,011.87
| Professional | | $1,731.16 | $2,586.88 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.20 / $2,589.29 / $4,429.57
| Professional | | $2,007.20 | $2,589.29 | $4,429.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.93 / $2,259.86 / $3,920.47
| Professional | | $1,657.93 | $2,259.86 | $3,920.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.41 / $2,308.28 / $2,854.15
| Professional | | $1,589.41 | $2,308.28 | $2,854.15 |