- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.31 / $1,868.08 / $2,925.18
| Professional | | $1,410.31 | $1,868.08 | $2,925.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.71 / $1,955.52 / $2,529.30
| Professional | | $1,581.71 | $1,955.52 | $2,529.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,818.91 / $2,352.62 / $2,853.80
| Professional | | $1,818.91 | $2,352.62 | $2,853.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $2,057.58 / $2,588.57
| Professional | | $32.34 | $2,057.58 | $2,588.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.53 / $2,432.09 / $2,909.00
| Professional | | $1,886.53 | $2,432.09 | $2,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,611.57 / $2,279.00 / $3,292.45
| Professional | | $1,611.57 | $2,279.00 | $3,292.45 |