- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.56 / $1,670.49 / $1,852.99
| Professional | | $1,538.56 | $1,670.49 | $1,852.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.97 / $1,797.42 / $2,282.71
| Professional | | $1,606.97 | $1,797.42 | $2,282.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.36 / $1,891.40 / $3,490.76
| Professional | | $1,276.36 | $1,891.40 | $3,490.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.49 / $1,795.02 / $2,969.53
| Professional | | $1,391.49 | $1,795.02 | $2,969.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.05 / $1,681.38 / $2,800.59
| Professional | | $1,281.05 | $1,681.38 | $2,800.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.53 / $1,384.53 / $1,955.90
| Professional | | $1,384.53 | $1,384.53 | $1,955.90 |