- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,922.90 / $2,061.71 / $9,919.41
| Professional | | $1,922.90 | $2,061.71 | $9,919.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.23 / $2,240.23 / $2,560.59
| Professional | | $2,240.23 | $2,240.23 | $2,560.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,750.37 / $2,589.55 / $5,221.87
| Professional | | $1,750.37 | $2,589.55 | $5,221.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,148.13 / $2,843.27 / $4,506.72
| Professional | | $2,148.13 | $2,843.27 | $4,506.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.22 / $2,460.73 / $4,104.87
| Professional | | $1,642.22 | $2,460.73 | $4,104.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.26 / $2,470.35 / $2,958.92
| Professional | | $1,738.26 | $2,470.35 | $2,958.92 |