- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.45 / $1,915.78 / $9,570.81
| Professional | | $1,844.45 | $1,915.78 | $9,570.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,077.51 / $2,086.44 / $2,384.81
| Professional | | $2,077.51 | $2,086.44 | $2,384.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.79 / $2,425.53 / $5,623.39
| Professional | | $1,766.79 | $2,425.53 | $5,623.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,854.22 / $2,466.11 / $3,956.79
| Professional | | $1,854.22 | $2,466.11 | $3,956.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.56 / $2,073.40 / $3,661.72
| Professional | | $1,558.56 | $2,073.40 | $3,661.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.11 / $2,132.35 / $2,653.14
| Professional | | $1,450.11 | $2,132.35 | $2,653.14 |