- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,468.06 / $1,601.21 / $2,414.52
| Professional | | $1,468.06 | $1,601.21 | $2,414.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.00 / $1,513.96 / $1,730.45
| Professional | | $1,460.00 | $1,513.96 | $1,730.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.17 / $1,640.82 / $3,296.33
| Professional | | $1,227.17 | $1,640.82 | $3,296.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.20 / $1,736.60 / $2,851.94
| Professional | | $1,346.20 | $1,736.60 | $2,851.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.31 / $1,578.84 / $2,522.17
| Professional | | $1,183.31 | $1,578.84 | $2,522.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.26 / $1,077.26 / $1,885.92
| Professional | | $1,077.26 | $1,077.26 | $1,885.92 |