- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.07 / $1,987.39 / $2,214.17
| Professional | | $1,825.07 | $1,987.39 | $2,214.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.07 / $2,107.69 / $2,676.78
| Professional | | $1,833.07 | $2,107.69 | $2,676.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,523.23 / $2,218.12 / $4,090.07
| Professional | | $1,523.23 | $2,218.12 | $4,090.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.16 / $2,155.80 / $3,541.95
| Professional | | $1,671.16 | $2,155.80 | $3,541.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.94 / $1,989.55 / $3,140.33
| Professional | | $1,446.94 | $1,989.55 | $3,140.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.65 / $1,541.65 / $2,341.19
| Professional | | $1,541.65 | $1,541.65 | $2,341.19 |