- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.73 / $1,481.15 / $2,622.91
| Professional | | $1,104.73 | $1,481.15 | $2,622.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.94 / $1,355.94 / $1,658.46
| Professional | | $1,355.94 | $1,355.94 | $1,658.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.20 / $1,455.73 / $3,066.59
| Professional | | $1,123.20 | $1,455.73 | $3,066.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.61 / $1,609.43 / $2,662.94
| Professional | | $1,247.61 | $1,609.43 | $2,662.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.74 / $1,410.20 / $2,470.63
| Professional | | $1,039.74 | $1,410.20 | $2,470.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.67 / $974.67 / $1,750.97
| Professional | | $974.67 | $974.67 | $1,750.97 |