- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.53 / $1,940.08 / $2,794.33
| Professional | | $1,780.53 | $1,940.08 | $2,794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,704.00 / $1,930.59 / $2,206.66
| Professional | | $1,704.00 | $1,930.59 | $2,206.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.74 / $1,992.86 / $3,994.22
| Professional | | $1,486.74 | $1,992.86 | $3,994.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.11 / $2,104.13 / $3,455.62
| Professional | | $1,631.11 | $2,104.13 | $3,455.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.70 / $1,914.58 / $3,298.64
| Professional | | $1,445.70 | $1,914.58 | $3,298.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.61 / $1,323.61 / $2,285.07
| Professional | | $1,323.61 | $1,323.61 | $2,285.07 |