- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.78 / $1,724.35 / $8,264.51
| Professional | | $1,602.78 | $1,724.35 | $8,264.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.70 / $1,866.34 / $2,388.92
| Professional | | $1,679.70 | $1,866.34 | $2,388.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.04 / $2,206.30 / $4,353.99
| Professional | | $1,521.04 | $2,206.30 | $4,353.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.58 / $2,313.71 / $3,760.76
| Professional | | $1,793.58 | $2,313.71 | $3,760.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.27 / $1,979.12 / $3,819.82
| Professional | | $1,372.27 | $1,979.12 | $3,819.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.34 / $2,062.62 / $2,472.66
| Professional | | $1,499.34 | $2,062.62 | $2,472.66 |