- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.75 / $1,896.31 / $9,465.83
| Professional | | $1,823.75 | $1,896.31 | $9,465.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.98 / $2,065.03 / $2,376.82
| Professional | | $2,061.98 | $2,065.03 | $2,376.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,750.77 / $2,394.83 / $5,558.32
| Professional | | $1,750.77 | $2,394.83 | $5,558.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.74 / $2,448.17 / $3,918.59
| Professional | | $1,840.74 | $2,448.17 | $3,918.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.82 / $2,171.66 / $3,649.74
| Professional | | $1,555.82 | $2,171.66 | $3,649.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.39 / $2,116.85 / $2,633.60
| Professional | | $1,449.39 | $2,116.85 | $2,633.60 |