- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.61 / $1,666.74 / $2,826.65
| Professional | | $1,526.61 | $1,666.74 | $2,826.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,607.05 / $1,784.54 / $2,039.73
| Professional | | $1,607.05 | $1,784.54 | $2,039.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.70 / $1,672.22 / $3,465.23
| Professional | | $1,285.70 | $1,672.22 | $3,465.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.63 / $1,809.39 / $2,996.32
| Professional | | $1,402.63 | $1,809.39 | $2,996.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.14 / $1,530.08 / $2,583.69
| Professional | | $1,129.14 | $1,530.08 | $2,583.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.93 / $1,103.93 / $1,969.76
| Professional | | $1,103.93 | $1,103.93 | $1,969.76 |