- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.10 / $2,071.63 / $3,332.67
| Professional | | $1,895.10 | $2,071.63 | $3,332.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.66 / $2,062.82 / $2,357.81
| Professional | | $1,820.66 | $2,062.82 | $2,357.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,588.57 / $2,129.90 / $4,268.39
| Professional | | $1,588.57 | $2,129.90 | $4,268.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.95 / $2,248.41 / $3,694.35
| Professional | | $1,742.95 | $2,248.41 | $3,694.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.38 / $1,997.65 / $3,094.75
| Professional | | $1,543.38 | $1,997.65 | $3,094.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.45 / $1,391.45 / $2,441.69
| Professional | | $1,391.45 | $1,391.45 | $2,441.69 |