- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.72 / $2,142.33 / $4,395.38
| Professional | | $1,968.72 | $2,142.33 | $4,395.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,070.29 / $2,303.80 / $2,633.24
| Professional | | $2,070.29 | $2,303.80 | $2,633.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,641.89 / $2,201.51 / $4,411.27
| Professional | | $1,641.89 | $2,201.51 | $4,411.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.44 / $2,323.86 / $3,820.03
| Professional | | $1,801.44 | $2,323.86 | $3,820.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.17 / $2,000.08 / $3,386.06
| Professional | | $1,512.17 | $2,000.08 | $3,386.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.29 / $1,466.29 / $2,523.67
| Professional | | $1,466.29 | $1,466.29 | $2,523.67 |