- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.57 / $1,813.99 / $4,317.60
| Professional | | $1,636.57 | $1,813.99 | $4,317.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.75 / $1,921.81 / $2,196.63
| Professional | | $1,763.75 | $1,921.81 | $2,196.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,390.58 / $1,806.76 / $3,733.04
| Professional | | $1,390.58 | $1,806.76 | $3,733.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.52 / $1,960.18 / $3,243.39
| Professional | | $1,519.52 | $1,960.18 | $3,243.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.74 / $1,655.05 / $2,802.33
| Professional | | $1,231.74 | $1,655.05 | $2,802.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.66 / $1,190.66 / $2,131.85
| Professional | | $1,190.66 | $1,190.66 | $2,131.85 |