- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.21 / $2,198.60 / $5,260.55
| Professional | | $2,000.21 | $2,198.60 | $5,260.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,127.66 / $2,301.42 / $3,575.00
| Professional | | $2,127.66 | $2,301.42 | $3,575.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,678.04 / $2,154.05 / $4,507.35
| Professional | | $1,678.04 | $2,154.05 | $4,507.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,834.43 / $2,366.41 / $3,918.08
| Professional | | $1,834.43 | $2,366.41 | $3,918.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.96 / $2,008.13 / $3,395.64
| Professional | | $1,481.96 | $2,008.13 | $3,395.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.21 / $1,442.21 / $2,573.30
| Professional | | $1,442.21 | $1,442.21 | $2,573.30 |