- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,510.53 / $2,049.85 / $4,412.84
| Professional | | $1,510.53 | $2,049.85 | $4,412.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.71 / $2,161.44 / $2,470.53
| Professional | | $2,001.71 | $2,161.44 | $2,470.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.33 / $2,035.15 / $4,236.27
| Professional | | $1,577.33 | $2,035.15 | $4,236.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.89 / $2,223.82 / $3,682.96
| Professional | | $1,723.89 | $2,223.82 | $3,682.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.38 / $1,884.92 / $3,433.59
| Professional | | $1,417.38 | $1,884.92 | $3,433.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.55 / $1,354.55 / $2,418.52
| Professional | | $1,354.55 | $1,354.55 | $2,418.52 |