- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.69 / $1,747.34 / $2,194.06
| Professional | | $1,602.69 | $1,747.34 | $2,194.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.80 / $1,713.11 / $2,175.65
| Professional | | $1,541.80 | $1,713.11 | $2,175.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.50 / $1,854.56 / $3,598.36
| Professional | | $1,339.50 | $1,854.56 | $3,598.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,439.88 / $1,895.53 / $3,113.26
| Professional | | $1,439.88 | $1,895.53 | $3,113.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.83 / $1,753.92 / $2,962.58
| Professional | | $1,258.83 | $1,753.92 | $2,962.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.16 / $1,330.16 / $2,058.63
| Professional | | $1,330.16 | $1,330.16 | $2,058.63 |