- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.03 / $2,251.01 / $5,085.26
| Professional | | $1,784.03 | $2,251.01 | $5,085.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.13 / $2,393.19 / $2,735.43
| Professional | | $2,196.13 | $2,393.19 | $2,735.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,731.29 / $2,260.11 / $4,652.33
| Professional | | $1,731.29 | $2,260.11 | $4,652.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,892.45 / $2,441.26 / $4,045.57
| Professional | | $1,892.45 | $2,441.26 | $4,045.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.62 / $2,161.13 / $3,743.30
| Professional | | $1,592.62 | $2,161.13 | $3,743.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.94 / $1,488.94 / $2,654.88
| Professional | | $1,488.94 | $1,488.94 | $2,654.88 |