- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.03 / $1,591.07 / $3,464.45
| Professional | | $1,265.03 | $1,591.07 | $3,464.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.52 / $2,408.96 / $3,664.72
| Professional | | $1,246.52 | $2,408.96 | $3,664.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,818.66 / $2,767.89 / $3,847.95
| Professional | | $1,818.66 | $2,767.89 | $3,847.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.53 / $2,456.46 / $3,060.80
| Professional | | $1,326.53 | $2,456.46 | $3,060.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.58 / $2,731.79 / $4,483.43
| Professional | | $1,433.58 | $2,731.79 | $4,483.43 |