- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.09 / $1,603.68 / $3,272.55
| Professional | | $1,463.09 | $1,603.68 | $3,272.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,564.08 / $1,662.98 / $2,240.00
| Professional | | $1,564.08 | $1,662.98 | $2,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.13 / $1,589.65 / $3,307.68
| Professional | | $1,203.13 | $1,589.65 | $3,307.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.74 / $1,734.71 / $2,873.56
| Professional | | $1,344.74 | $1,734.71 | $2,873.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.15 / $1,541.89 / $3,056.68
| Professional | | $1,118.15 | $1,541.89 | $3,056.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.59 / $1,052.59 / $1,887.23
| Professional | | $1,052.59 | $1,052.59 | $1,887.23 |