- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.72 / $1,240.75 / $1,589.65
| Professional | | $1,094.72 | $1,240.75 | $1,589.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.04 / $1,927.52 / $2,873.14
| Professional | | $1,124.04 | $1,927.52 | $2,873.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.18 / $2,163.59 / $3,450.93
| Professional | | $1,507.18 | $2,163.59 | $3,450.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.79 / $2,111.11 / $3,971.68
| Professional | | $1,286.79 | $2,111.11 | $3,971.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.71 / $1,841.09 / $4,096.64
| Professional | | $1,363.71 | $1,841.09 | $4,096.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.10 / $1,040.71 / $1,324.54
| Professional | | $946.10 | $1,040.71 | $1,324.54 |