- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.32 / $1,292.24 / $1,625.22
| Professional | | $1,141.32 | $1,292.24 | $1,625.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.56 / $1,686.97 / $2,310.65
| Professional | | $1,303.56 | $1,686.97 | $2,310.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.52 / $1,863.73 / $2,715.10
| Professional | | $1,220.52 | $1,863.73 | $2,715.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.06 / $1,745.98 / $2,678.43
| Professional | | $1,509.06 | $1,745.98 | $2,678.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.52 / $1,292.24 / $1,625.22
| Professional | | $1,019.52 | $1,292.24 | $1,625.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.17 / $1,801.81 / $2,416.89
| Professional | | $1,235.17 | $1,801.81 | $2,416.89 |