- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.57 / $1,254.17 / $1,638.47
| Professional | | $1,051.57 | $1,254.17 | $1,638.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.76 / $1,306.78 / $1,799.10
| Professional | | $1,110.76 | $1,306.78 | $1,799.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.04 / $1,483.38 / $2,367.09
| Professional | | $1,052.04 | $1,483.38 | $2,367.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,341.01 / $1,873.72 / $2,993.31
| Professional | | $1,341.01 | $1,873.72 | $2,993.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $758.92 / $1,469.29
| Professional | | $32.34 | $758.92 | $1,469.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.01 / $2,029.46 / $2,970.62
| Professional | | $1,415.01 | $2,029.46 | $2,970.62 |