- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.72 / $1,675.83 / $4,141.83
| Professional | | $1,353.72 | $1,675.83 | $4,141.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.00 / $1,729.04 / $1,976.30
| Professional | | $1,490.00 | $1,729.04 | $1,976.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.12 / $1,973.05 / $3,629.71
| Professional | | $1,386.12 | $1,973.05 | $3,629.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.98 / $2,006.84 / $3,021.71
| Professional | | $1,518.98 | $2,006.84 | $3,021.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.90 / $1,686.34 / $2,923.60
| Professional | | $1,184.90 | $1,686.34 | $2,923.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.19 / $1,746.83 / $2,136.13
| Professional | | $1,135.19 | $1,746.83 | $2,136.13 |