- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.01 / $1,305.97 / $1,496.74
| Professional | | $1,111.01 | $1,305.97 | $1,496.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,268.47 / $1,325.81 / $1,515.40
| Professional | | $1,268.47 | $1,325.81 | $1,515.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.69 / $1,307.08 / $2,716.74
| Professional | | $1,003.69 | $1,307.08 | $2,716.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.55 / $1,410.68 / $2,340.33
| Professional | | $1,093.55 | $1,410.68 | $2,340.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.89 / $1,233.10 / $2,381.80
| Professional | | $947.89 | $1,233.10 | $2,381.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.69 / $934.69 / $1,537.46
| Professional | | $934.69 | $934.69 | $1,537.46 |