- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.08 / $2,313.12 / $5,063.24
| Professional | | $1,832.08 | $2,313.12 | $5,063.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.07 / $2,466.94 / $2,819.70
| Professional | | $2,248.07 | $2,466.94 | $2,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,774.58 / $2,317.90 / $4,771.68
| Professional | | $1,774.58 | $2,317.90 | $4,771.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.21 / $2,504.16 / $4,153.01
| Professional | | $1,941.21 | $2,504.16 | $4,153.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.06 / $2,144.38 / $3,615.42
| Professional | | $1,554.06 | $2,144.38 | $3,615.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.49 / $1,535.49 / $2,722.58
| Professional | | $1,535.49 | $1,535.49 | $2,722.58 |