- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.58 / $1,747.24 / $1,934.72
| Professional | | $1,274.58 | $1,747.24 | $1,934.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.42 / $1,700.52 / $2,077.23
| Professional | | $1,547.42 | $1,700.52 | $2,077.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,341.43 / $1,753.93 / $3,613.58
| Professional | | $1,341.43 | $1,753.93 | $3,613.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.30 / $1,891.53 / $3,141.45
| Professional | | $1,466.30 | $1,891.53 | $3,141.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.32 / $1,644.75 / $2,905.10
| Professional | | $1,236.32 | $1,644.75 | $2,905.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.76 / $1,155.76 / $2,057.09
| Professional | | $1,155.76 | $1,155.76 | $2,057.09 |