- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.80 / $1,968.13 / $5,445.19
| Professional | | $1,863.80 | $1,968.13 | $5,445.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.03 / $2,140.44 / $2,446.53
| Professional | | $1,657.03 | $2,140.44 | $2,446.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.07 / $2,522.23 / $4,976.28
| Professional | | $1,752.07 | $2,522.23 | $4,976.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.96 / $2,644.45 / $4,298.78
| Professional | | $2,049.96 | $2,644.45 | $4,298.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.12 / $2,206.48 / $3,909.37
| Professional | | $1,603.12 | $2,206.48 | $3,909.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.29 / $2,357.44 / $2,824.58
| Professional | | $1,733.29 | $2,357.44 | $2,824.58 |