- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.13 / $1,580.14 / $2,490.29
| Professional | | $1,430.13 | $1,580.14 | $2,490.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.45 / $1,667.65 / $1,950.00
| Professional | | $1,541.45 | $1,667.65 | $1,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.44 / $1,566.02 / $3,258.45
| Professional | | $1,214.44 | $1,566.02 | $3,258.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.47 / $1,711.15 / $2,828.02
| Professional | | $1,326.47 | $1,711.15 | $2,828.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.33 / $1,439.07 / $2,605.28
| Professional | | $1,125.33 | $1,439.07 | $2,605.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.73 / $1,036.73 / $1,861.30
| Professional | | $1,036.73 | $1,036.73 | $1,861.30 |