- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.25 / $1,414.24 / $2,249.66
| Professional | | $1,150.25 | $1,414.24 | $2,249.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.26 / $1,460.04 / $2,811.79
| Professional | | $1,109.26 | $1,460.04 | $2,811.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,573.87 / $2,108.82 / $3,164.31
| Professional | | $1,573.87 | $2,108.82 | $3,164.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.26 / $995.26 / $995.26
| Professional | | $995.26 | $995.26 | $995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.60 / $1,047.12 / $1,939.07
| Professional | | $150.60 | $1,047.12 | $1,939.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.52 / $1,761.93 / $3,237.21
| Professional | | $1,258.52 | $1,761.93 | $3,237.21 |