- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.16 / $2,139.25 / $5,462.69
| Professional | | $1,937.16 | $2,139.25 | $5,462.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.40 / $2,112.92 / $2,415.08
| Professional | | $2,097.40 | $2,112.92 | $2,415.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,873.78 / $2,615.85 / $5,062.66
| Professional | | $1,873.78 | $2,615.85 | $5,062.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.68 / $2,699.47 / $4,425.24
| Professional | | $2,029.68 | $2,699.47 | $4,425.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.02 / $2,335.15 / $4,656.89
| Professional | | $1,740.02 | $2,335.15 | $4,656.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,785.32 / $2,334.13 / $2,887.98
| Professional | | $1,785.32 | $2,334.13 | $2,887.98 |