- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.97 / $1,217.86 / $1,871.46
| Professional | | $1,034.97 | $1,217.86 | $1,871.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.08 / $1,637.18 / $2,340.94
| Professional | | $1,265.08 | $1,637.18 | $2,340.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.91 / $1,796.88 / $2,534.23
| Professional | | $1,233.91 | $1,796.88 | $2,534.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.85 / $1,768.88 / $2,713.56
| Professional | | $1,528.85 | $1,768.88 | $2,713.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.58 / $1,310.45 / $1,468.05
| Professional | | $948.58 | $1,310.45 | $1,468.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.72 / $1,574.75 / $2,360.75
| Professional | | $1,115.72 | $1,574.75 | $2,360.75 |