- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,765.09 / $1,921.77 / $3,032.62
| Professional | | $1,765.09 | $1,921.77 | $3,032.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.83 / $1,880.19 / $2,380.00
| Professional | | $1,772.83 | $1,880.19 | $2,380.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.60 / $1,974.93 / $3,957.54
| Professional | | $1,473.60 | $1,974.93 | $3,957.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.87 / $2,085.76 / $3,425.30
| Professional | | $1,616.87 | $2,085.76 | $3,425.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.74 / $1,966.36 / $3,242.93
| Professional | | $1,386.74 | $1,966.36 | $3,242.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.29 / $1,346.29 / $2,265.02
| Professional | | $1,346.29 | $1,346.29 | $2,265.02 |