- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.84 / $1,534.36 / $2,077.11
| Professional | | $1,343.84 | $1,534.36 | $2,077.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.58 / $1,774.69 / $2,623.54
| Professional | | $1,441.58 | $1,774.69 | $2,623.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,572.61 / $2,077.11 / $2,921.45
| Professional | | $1,572.61 | $2,077.11 | $2,921.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.93 / $1,694.14 / $2,636.08
| Professional | | $1,521.93 | $1,694.14 | $2,636.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.54 / $1,478.23 / $2,077.11
| Professional | | $1,214.54 | $1,478.23 | $2,077.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.28 / $1,949.19 / $2,520.51
| Professional | | $1,377.28 | $1,949.19 | $2,520.51 |