- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.29 / $2,194.17 / $2,446.11
| Professional | | $2,017.29 | $2,194.17 | $2,446.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.65 / $1,944.19 / $2,469.12
| Professional | | $1,928.65 | $1,944.19 | $2,469.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.52 / $2,135.01 / $4,521.30
| Professional | | $1,682.52 | $2,135.01 | $4,521.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,846.03 / $2,381.38 / $3,914.43
| Professional | | $1,846.03 | $2,381.38 | $3,914.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.57 / $2,089.94 / $3,707.44
| Professional | | $1,585.57 | $2,089.94 | $3,707.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.50 / $1,470.50 / $2,586.15
| Professional | | $1,470.50 | $1,470.50 | $2,586.15 |