- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.22 / $1,820.72 / $8,456.54
| Professional | | $1,567.22 | $1,820.72 | $8,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,844.05 / $1,916.20 / $2,190.21
| Professional | | $1,844.05 | $1,916.20 | $2,190.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.42 / $2,143.87 / $4,970.08
| Professional | | $1,557.42 | $2,143.87 | $4,970.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.98 / $2,187.82 / $3,500.51
| Professional | | $1,644.98 | $2,187.82 | $3,500.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.59 / $1,967.06 / $3,903.39
| Professional | | $1,430.59 | $1,967.06 | $3,903.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.98 / $1,891.73 / $2,353.37
| Professional | | $1,321.98 | $1,891.73 | $2,353.37 |