- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.11 / $1,246.47 / $1,571.81
| Professional | | $1,141.11 | $1,246.47 | $1,571.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,269.39 / $1,535.96
| Professional | | $1,020.00 | $1,269.39 | $1,535.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.63 / $1,403.36 / $2,602.09
| Professional | | $955.63 | $1,403.36 | $2,602.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.85 / $1,351.74 / $2,218.78
| Professional | | $1,047.85 | $1,351.74 | $2,218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.53 / $1,239.13 / $1,960.37
| Professional | | $921.53 | $1,239.13 | $1,960.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.81 / $973.81 / $1,468.23
| Professional | | $973.81 | $973.81 | $1,468.23 |