- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.11 / $1,442.42 / $3,364.20
| Professional | | $1,132.11 | $1,442.42 | $3,364.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.47 / $2,219.48 / $3,180.30
| Professional | | $1,148.47 | $2,219.48 | $3,180.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.69 / $2,369.46 / $3,321.28
| Professional | | $1,635.69 | $2,369.46 | $3,321.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.77 / $2,150.10 / $2,641.38
| Professional | | $1,144.77 | $2,150.10 | $2,641.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.38 / $2,255.64 / $3,943.06
| Professional | | $1,244.38 | $2,255.64 | $3,943.06 |