- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.28 / $2,217.34 / $2,435.91
| Professional | | $2,018.28 | $2,217.34 | $2,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.62 / $1,988.46 / $2,525.34
| Professional | | $1,789.62 | $1,988.46 | $2,525.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,692.05 / $2,137.59 / $4,548.57
| Professional | | $1,692.05 | $2,137.59 | $4,548.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.38 / $2,386.14 / $3,953.30
| Professional | | $1,807.38 | $2,386.14 | $3,953.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.02 / $2,022.29 / $3,655.29
| Professional | | $1,555.02 | $2,022.29 | $3,655.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.68 / $1,450.68 / $2,594.79
| Professional | | $1,450.68 | $1,450.68 | $2,594.79 |