- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.69 / $2,040.93 / $4,158.21
| Professional | | $1,872.69 | $2,040.93 | $4,158.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,979.14 / $2,191.86 / $2,505.30
| Professional | | $1,979.14 | $2,191.86 | $2,505.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.96 / $2,068.71 / $4,221.30
| Professional | | $1,568.96 | $2,068.71 | $4,221.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.17 / $2,203.54 / $3,657.27
| Professional | | $1,708.17 | $2,203.54 | $3,657.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.12 / $1,882.37 / $3,647.24
| Professional | | $1,419.12 | $1,882.37 | $3,647.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.89 / $1,350.89 / $2,401.96
| Professional | | $1,350.89 | $1,350.89 | $2,401.96 |