- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.10 / $1,652.45 / $1,997.47
| Professional | | $1,328.10 | $1,652.45 | $1,997.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.06 / $1,963.17 / $2,833.70
| Professional | | $1,189.06 | $1,963.17 | $2,833.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.28 / $2,747.54 / $4,518.43
| Professional | | $1,713.28 | $2,747.54 | $4,518.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.91 / $2,546.19 / $4,843.08
| Professional | | $1,485.91 | $2,546.19 | $4,843.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.12 / $2,583.83 / $4,383.37
| Professional | | $1,807.12 | $2,583.83 | $4,383.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.65 / $1,262.13 / $1,514.56
| Professional | | $1,007.65 | $1,262.13 | $1,514.56 |