- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.19 / $2,189.83 / $6,433.00
| Professional | | $2,025.19 | $2,189.83 | $6,433.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.00 / $2,274.38 / $2,599.61
| Professional | | $1,810.00 | $2,274.38 | $2,599.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.19 / $2,557.94 / $5,508.37
| Professional | | $1,648.19 | $2,557.94 | $5,508.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,232.62 / $2,880.08 / $4,856.93
| Professional | | $2,232.62 | $2,880.08 | $4,856.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.93 / $2,385.65 / $4,343.85
| Professional | | $1,539.93 | $2,385.65 | $4,343.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.54 / $2,567.51 / $3,088.62
| Professional | | $1,672.54 | $2,567.51 | $3,088.62 |