- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.10 / $1,884.91 / $3,751.28
| Professional | | $1,395.10 | $1,884.91 | $3,751.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.06 / $1,992.86 / $2,277.83
| Professional | | $1,835.06 | $1,992.86 | $2,277.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.61 / $1,878.75 / $3,893.62
| Professional | | $1,448.61 | $1,878.75 | $3,893.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.19 / $2,043.61 / $3,389.43
| Professional | | $1,584.19 | $2,043.61 | $3,389.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.94 / $1,790.05 / $2,944.36
| Professional | | $1,285.94 | $1,790.05 | $2,944.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.08 / $1,251.08 / $2,222.02
| Professional | | $1,251.08 | $1,251.08 | $2,222.02 |