- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.56 / $2,007.84 / $8,844.48
| Professional | | $1,679.56 | $2,007.84 | $8,844.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,831.13 / $2,034.59 / $2,604.28
| Professional | | $1,831.13 | $2,034.59 | $2,604.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.66 / $2,440.94 / $4,428.95
| Professional | | $1,495.66 | $2,440.94 | $4,428.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.99 / $2,301.39 / $3,810.56
| Professional | | $1,748.99 | $2,301.39 | $3,810.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.64 / $1,956.37 / $3,535.92
| Professional | | $1,388.64 | $1,956.37 | $3,535.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.90 / $2,051.62 / $2,503.13
| Professional | | $1,399.90 | $2,051.62 | $2,503.13 |