- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.33 / $1,622.63 / $3,312.46
| Professional | | $1,176.33 | $1,622.63 | $3,312.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.22 / $1,546.72 / $2,060.00
| Professional | | $1,444.22 | $1,546.72 | $2,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.36 / $1,586.67 / $3,359.05
| Professional | | $1,251.36 | $1,586.67 | $3,359.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,366.85 / $1,763.24 / $2,917.54
| Professional | | $1,366.85 | $1,763.24 | $2,917.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.58 / $1,496.43 / $2,725.50
| Professional | | $1,141.58 | $1,496.43 | $2,725.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.56 / $1,069.56 / $1,917.96
| Professional | | $1,069.56 | $1,069.56 | $1,917.96 |