- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.84 / $1,746.48 / $2,845.09
| Professional | | $1,603.84 | $1,746.48 | $2,845.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,575.00 / $1,857.70 / $2,123.35
| Professional | | $1,575.00 | $1,857.70 | $2,123.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.05 / $1,761.74 / $3,618.08
| Professional | | $1,344.05 | $1,761.74 | $3,618.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.05 / $1,887.33 / $3,135.70
| Professional | | $1,463.05 | $1,887.33 | $3,135.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.23 / $1,610.86 / $2,723.36
| Professional | | $1,171.23 | $1,610.86 | $2,723.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.89 / $1,154.89 / $2,057.42
| Professional | | $1,154.89 | $1,154.89 | $2,057.42 |