- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.30 / $1,532.96 / $2,624.09
| Professional | | $1,224.30 | $1,532.96 | $2,624.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.39 / $1,621.08 / $3,672.46
| Professional | | $1,305.39 | $1,621.08 | $3,672.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,685.07 / $1,685.07 / $2,066.56
| Professional | | $1,685.07 | $1,685.07 | $2,066.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.21 / $2,252.10 / $5,083.68
| Professional | | $1,274.21 | $2,252.10 | $5,083.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.85 / $2,330.08 / $3,255.64
| Professional | | $1,723.85 | $2,330.08 | $3,255.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.14 / $1,747.12 / $3,081.96
| Professional | | $1,115.14 | $1,747.12 | $3,081.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.10 / $2,300.98 / $5,195.92
| Professional | | $1,360.10 | $2,300.98 | $5,195.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.35 / $1,901.56 / $4,660.60
| Professional | | $1,365.35 | $1,901.56 | $4,660.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.14 / $1,942.58 / $3,081.96
| Professional | | $1,115.14 | $1,942.58 | $3,081.96 |