- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.93 / $1,478.13 / $1,812.44
| Professional | | $1,178.93 | $1,478.13 | $1,812.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.93 / $1,388.53 / $1,591.96
| Professional | | $1,327.93 | $1,388.53 | $1,591.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,214.66 / $1,995.48 / $3,781.51
| Professional | | $1,214.66 | $1,995.48 | $3,781.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.73 / $2,072.67 / $2,726.58
| Professional | | $1,606.73 | $2,072.67 | $2,726.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.58 / $1,709.38 / $2,992.85
| Professional | | $1,265.58 | $1,709.38 | $2,992.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.59 / $1,847.74 / $2,299.46
| Professional | | $1,255.59 | $1,847.74 | $2,299.46 |