- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.39 / $1,762.90 / $4,080.19
| Professional | | $1,401.39 | $1,762.90 | $4,080.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.00 / $1,908.60 / $2,181.53
| Professional | | $1,850.00 | $1,908.60 | $2,181.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.24 / $2,247.59 / $4,444.72
| Professional | | $1,581.24 | $2,247.59 | $4,444.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.74 / $2,406.67 / $3,841.41
| Professional | | $1,833.74 | $2,406.67 | $3,841.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.78 / $2,002.22 / $3,602.84
| Professional | | $1,444.78 | $2,002.22 | $3,602.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.97 / $2,108.80 / $2,528.54
| Professional | | $1,563.97 | $2,108.80 | $2,528.54 |