- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.58 / $1,488.48 / $2,440.52
| Professional | | $1,193.58 | $1,488.48 | $2,440.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.73 / $2,265.34 / $4,658.18
| Professional | | $1,318.73 | $2,265.34 | $4,658.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.04 / $2,395.56 / $2,843.22
| Professional | | $1,807.04 | $2,395.56 | $2,843.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.54 / $1,575.18 / $3,426.54
| Professional | | $1,103.54 | $1,575.18 | $3,426.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.46 / $1,879.90 / $4,204.93
| Professional | | $1,213.46 | $1,879.90 | $4,204.93 |