- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.41 / $1,788.53 / $2,665.14
| Professional | | $1,642.41 | $1,788.53 | $2,665.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.00 / $1,651.18 / $1,887.30
| Professional | | $1,560.00 | $1,651.18 | $1,887.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.01 / $1,780.35 / $3,707.23
| Professional | | $1,376.01 | $1,780.35 | $3,707.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.88 / $1,932.27 / $3,212.01
| Professional | | $1,497.88 | $1,932.27 | $3,212.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.56 / $1,740.08 / $3,471.18
| Professional | | $1,265.56 | $1,740.08 | $3,471.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.82 / $1,186.82 / $2,106.33
| Professional | | $1,186.82 | $1,186.82 | $2,106.33 |