- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.31 / $1,337.63 / $2,606.69
| Professional | | $1,066.31 | $1,337.63 | $2,606.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.37 / $1,425.29 / $1,629.11
| Professional | | $1,312.37 | $1,425.29 | $1,629.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.18 / $1,345.28 / $2,771.79
| Professional | | $1,033.18 | $1,345.28 | $2,771.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.24 / $1,455.43 / $2,407.98
| Professional | | $1,128.24 | $1,455.43 | $2,407.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.91 / $1,224.28 / $2,212.89
| Professional | | $904.91 | $1,224.28 | $2,212.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.69 / $880.69 / $1,583.25
| Professional | | $880.69 | $880.69 | $1,583.25 |