- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.17 / $1,544.65 / $1,876.36
| Professional | | $1,254.17 | $1,544.65 | $1,876.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.36 / $1,820.03 / $2,649.62
| Professional | | $1,102.36 | $1,820.03 | $2,649.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.11 / $2,500.19 / $4,210.13
| Professional | | $1,567.11 | $2,500.19 | $4,210.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.58 / $2,396.67 / $4,490.00
| Professional | | $1,377.58 | $2,396.67 | $4,490.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.73 / $2,317.19 / $4,115.06
| Professional | | $1,694.73 | $2,317.19 | $4,115.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.41 / $1,170.00 / $1,404.00
| Professional | | $927.41 | $1,170.00 | $1,404.00 |