- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.05 / $1,286.50 / $1,571.10
| Professional | | $1,080.05 | $1,286.50 | $1,571.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.06 / $1,350.25 / $1,512.28
| Professional | | $1,226.06 | $1,350.25 | $1,512.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.68 / $1,713.80 / $3,376.98
| Professional | | $1,114.68 | $1,713.80 | $3,376.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.27 / $1,788.29 / $2,357.71
| Professional | | $1,386.27 | $1,788.29 | $2,357.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.09 / $1,631.12 / $2,963.98
| Professional | | $1,135.09 | $1,631.12 | $2,963.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.69 / $1,594.21 / $1,983.18
| Professional | | $1,153.69 | $1,594.21 | $1,983.18 |