- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.41 / $2,043.45 / $9,829.82
| Professional | | $1,906.41 | $2,043.45 | $9,829.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.17 / $2,108.64 / $2,410.17
| Professional | | $1,718.17 | $2,108.64 | $2,410.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.06 / $2,524.62 / $5,176.96
| Professional | | $1,702.06 | $2,524.62 | $5,176.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,127.78 / $2,829.95 / $4,466.55
| Professional | | $2,127.78 | $2,829.95 | $4,466.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.71 / $2,323.36 / $4,789.58
| Professional | | $1,615.71 | $2,323.36 | $4,789.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.07 / $2,446.94 / $2,930.42
| Professional | | $1,706.07 | $2,446.94 | $2,930.42 |