- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,781.46 / $1,927.26 / $3,436.05
| Professional | | $1,781.46 | $1,927.26 | $3,436.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,731.18 / $2,077.37 / $2,374.42
| Professional | | $1,731.18 | $2,077.37 | $2,374.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.91 / $1,818.36 / $3,975.53
| Professional | | $1,383.91 | $1,818.36 | $3,975.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,605.39 / $2,070.94 / $3,423.31
| Professional | | $1,605.39 | $2,070.94 | $3,423.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.56 / $1,652.09 / $3,040.56
| Professional | | $1,092.56 | $1,652.09 | $3,040.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.32 / $1,293.32 / $2,256.38
| Professional | | $1,293.32 | $1,293.32 | $2,256.38 |