- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,725.71 / $2,061.57 / $9,049.41
| Professional | | $1,725.71 | $2,061.57 | $9,049.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.37 / $2,210.46 / $2,526.56
| Professional | | $2,028.37 | $2,210.46 | $2,526.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.85 / $2,419.35 / $4,547.53
| Professional | | $1,693.85 | $2,419.35 | $4,547.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.28 / $2,436.92 / $3,918.40
| Professional | | $1,832.28 | $2,436.92 | $3,918.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,561.25 / $2,120.19 / $3,625.34
| Professional | | $1,561.25 | $2,120.19 | $3,625.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,438.46 / $2,107.12 / $2,570.16
| Professional | | $1,438.46 | $2,107.12 | $2,570.16 |