- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.78 / $1,618.77 / $2,283.04
| Professional | | $1,483.78 | $1,618.77 | $2,283.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.85 / $1,507.10 / $2,100.00
| Professional | | $1,492.85 | $1,507.10 | $2,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.08 / $1,740.10 / $3,342.40
| Professional | | $1,240.08 | $1,740.10 | $3,342.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.50 / $1,755.05 / $2,881.61
| Professional | | $1,360.50 | $1,755.05 | $2,881.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.67 / $1,661.21 / $2,924.18
| Professional | | $1,189.67 | $1,661.21 | $2,924.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.49 / $1,079.49 / $1,905.88
| Professional | | $1,079.49 | $1,079.49 | $1,905.88 |