- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.40 / $1,868.01 / $2,232.38
| Professional | | $1,477.40 | $1,868.01 | $2,232.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.68 / $2,395.00 / $3,385.31
| Professional | | $1,850.68 | $2,395.00 | $3,385.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.09 / $2,691.77 / $3,797.34
| Professional | | $1,797.09 | $2,691.77 | $3,797.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,210.21 / $2,557.21 / $3,922.92
| Professional | | $2,210.21 | $2,557.21 | $3,922.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,477.40 / $2,205.96 / $2,232.38
| Professional | | $1,477.40 | $2,205.96 | $2,232.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.61 / $2,462.46 / $3,439.10
| Professional | | $1,696.61 | $2,462.46 | $3,439.10 |