- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.95 / $1,450.35 / $1,915.09
| Professional | | $1,192.95 | $1,450.35 | $1,915.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.12 / $1,578.39 / $1,804.10
| Professional | | $1,530.12 | $1,578.39 | $1,804.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.29 / $1,887.51 / $3,418.20
| Professional | | $1,263.29 | $1,887.51 | $3,418.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.35 / $1,835.87 / $2,949.29
| Professional | | $1,380.35 | $1,835.87 | $2,949.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.29 / $1,563.66 / $2,721.73
| Professional | | $1,113.29 | $1,563.66 | $2,721.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.49 / $1,587.40 / $1,936.73
| Professional | | $1,084.49 | $1,587.40 | $1,936.73 |