- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.40 / $1,991.79 / $9,260.66
| Professional | | $1,716.40 | $1,991.79 | $9,260.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.78 / $2,096.59 / $2,396.40
| Professional | | $2,016.78 | $2,096.59 | $2,396.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.49 / $2,349.76 / $5,437.94
| Professional | | $1,718.49 | $2,349.76 | $5,437.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,800.31 / $2,394.41 / $3,832.68
| Professional | | $1,800.31 | $2,394.41 | $3,832.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.97 / $2,100.90 / $3,799.92
| Professional | | $1,529.97 | $2,100.90 | $3,799.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.73 / $2,070.36 / $2,575.82
| Professional | | $1,408.73 | $2,070.36 | $2,575.82 |