- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.51 / $2,305.23 / $10,148.40
| Professional | | $1,881.51 | $2,305.23 | $10,148.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,650.00 / $2,364.21 / $2,702.29
| Professional | | $1,650.00 | $2,364.21 | $2,702.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.67 / $2,551.01 / $4,941.93
| Professional | | $1,716.67 | $2,551.01 | $4,941.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,979.37 / $2,553.39 / $4,369.49
| Professional | | $1,979.37 | $2,553.39 | $4,369.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.67 / $2,291.35 / $3,867.71
| Professional | | $1,589.67 | $2,291.35 | $3,867.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.90 / $2,276.28 / $2,814.47
| Professional | | $1,567.90 | $2,276.28 | $2,814.47 |