- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,753.06 / $1,911.09 / $3,058.31
| Professional | | $1,753.06 | $1,911.09 | $3,058.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.82 / $1,766.55 / $2,184.98
| Professional | | $1,756.82 | $1,766.55 | $2,184.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.01 / $1,840.81 / $3,937.21
| Professional | | $1,459.01 | $1,840.81 | $3,937.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.45 / $2,050.39 / $3,401.03
| Professional | | $1,589.45 | $2,050.39 | $3,401.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.01 / $1,760.73 / $2,981.27
| Professional | | $1,357.01 | $1,760.73 | $2,981.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.20 / $1,266.20 / $2,234.63
| Professional | | $1,266.20 | $1,266.20 | $2,234.63 |