- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.90 / $1,732.58 / $2,603.57
| Professional | | $1,532.90 | $1,732.58 | $2,603.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.74 / $2,256.60 / $3,192.98
| Professional | | $1,743.74 | $2,256.60 | $3,192.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.75 / $2,527.44 / $3,577.93
| Professional | | $1,695.75 | $2,527.44 | $3,577.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,085.32 / $2,412.71 / $3,701.23
| Professional | | $2,085.32 | $2,412.71 | $3,701.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.78 / $2,011.87 / $3,129.22
| Professional | | $1,409.78 | $2,011.87 | $3,129.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.61 / $2,209.09 / $3,592.67
| Professional | | $1,549.61 | $2,209.09 | $3,592.67 |