- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.20 / $1,962.02 / $3,006.52
| Professional | | $1,461.20 | $1,962.02 | $3,006.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.01 / $2,054.56 / $2,807.89
| Professional | | $1,642.01 | $2,054.56 | $2,807.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,903.24 / $2,385.71 / $2,930.79
| Professional | | $1,903.24 | $2,385.71 | $2,930.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $2,089.90 / $2,629.22
| Professional | | $32.34 | $2,089.90 | $2,629.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.34 / $2,466.65 / $2,969.68
| Professional | | $1,974.34 | $2,466.65 | $2,969.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.42 / $2,353.87 / $3,371.45
| Professional | | $1,656.42 | $2,353.87 | $3,371.45 |