- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,725.26 / $1,915.58 / $4,182.52
| Professional | | $1,725.26 | $1,915.58 | $4,182.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,855.39 / $2,024.66 / $2,700.00
| Professional | | $1,855.39 | $2,024.66 | $2,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.34 / $1,895.86 / $3,930.61
| Professional | | $1,463.34 | $1,895.86 | $3,930.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,599.67 / $2,063.57 / $3,417.65
| Professional | | $1,599.67 | $2,063.57 | $3,417.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.01 / $1,791.76 / $3,853.31
| Professional | | $1,343.01 | $1,791.76 | $3,853.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.78 / $1,255.78 / $2,243.96
| Professional | | $1,255.78 | $1,255.78 | $2,243.96 |