- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.25 / $1,777.12 / $2,780.51
| Professional | | $1,348.25 | $1,777.12 | $2,780.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.90 / $1,923.96 / $2,437.02
| Professional | | $1,439.90 | $1,923.96 | $2,437.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,799.16 / $2,180.80 / $2,655.12
| Professional | | $1,799.16 | $2,180.80 | $2,655.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,884.52 / $2,127.69
| Professional | | $32.34 | $1,884.52 | $2,127.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,877.46 / $2,271.21 / $2,936.39
| Professional | | $1,877.46 | $2,271.21 | $2,936.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.45 / $2,152.07 / $3,043.65
| Professional | | $1,526.45 | $2,152.07 | $3,043.65 |