- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.69 / $1,324.15 / $2,212.29
| Professional | | $1,069.69 | $1,324.15 | $2,212.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.83 / $1,672.19 / $2,671.74
| Professional | | $1,362.83 | $1,672.19 | $2,671.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.38 / $1,937.97 / $3,080.65
| Professional | | $1,331.38 | $1,937.97 | $3,080.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,573.15 / $2,375.83 / $10,902.32
| Professional | | $1,573.15 | $2,375.83 | $10,902.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.30 / $1,922.80 / $3,111.50
| Professional | | $1,467.30 | $1,922.80 | $3,111.50 |