- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.46 / $1,593.28 / $1,926.74
| Professional | | $1,296.46 | $1,593.28 | $1,926.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.48 / $1,904.41 / $2,724.20
| Professional | | $1,153.48 | $1,904.41 | $2,724.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.51 / $2,638.04 / $4,288.74
| Professional | | $1,647.51 | $2,638.04 | $4,288.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.45 / $2,430.39 / $4,646.42
| Professional | | $1,441.45 | $2,430.39 | $4,646.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.68 / $2,429.80 / $4,207.97
| Professional | | $1,670.68 | $2,429.80 | $4,207.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.83 / $1,367.56 / $1,728.83
| Professional | | $976.83 | $1,367.56 | $1,728.83 |