- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.01 / $1,784.69 / $2,291.30
| Professional | | $1,631.01 | $1,784.69 | $2,291.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.90 / $1,898.82 / $2,170.35
| Professional | | $1,733.90 | $1,898.82 | $2,170.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.62 / $1,751.93 / $3,696.89
| Professional | | $1,373.62 | $1,751.93 | $3,696.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.46 / $1,929.14 / $3,204.08
| Professional | | $1,495.46 | $1,929.14 | $3,204.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.83 / $1,643.91 / $2,783.47
| Professional | | $1,264.83 | $1,643.91 | $2,783.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.27 / $1,172.27 / $2,102.82
| Professional | | $1,172.27 | $1,172.27 | $2,102.82 |