- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,948.57 / $2,123.76 / $2,730.36
| Professional | | $1,948.57 | $2,123.76 | $2,730.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.88 / $2,078.65 / $2,375.89
| Professional | | $1,864.88 | $2,078.65 | $2,375.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.41 / $2,141.78 / $4,382.60
| Professional | | $1,625.41 | $2,141.78 | $4,382.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.16 / $2,283.51 / $3,790.74
| Professional | | $1,770.16 | $2,283.51 | $3,790.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.04 / $1,963.11 / $3,796.23
| Professional | | $1,425.04 | $1,963.11 | $3,796.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,376.01 / $1,376.01 / $2,489.01
| Professional | | $1,376.01 | $1,376.01 | $2,489.01 |