- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.50 / $1,651.01 / $3,774.76
| Professional | | $1,480.50 | $1,651.01 | $3,774.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.76 / $1,750.67 / $2,001.02
| Professional | | $1,608.76 | $1,750.67 | $2,001.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.84 / $1,634.84 / $3,401.87
| Professional | | $1,267.84 | $1,634.84 | $3,401.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.04 / $1,786.70 / $2,954.14
| Professional | | $1,385.04 | $1,786.70 | $2,954.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.22 / $1,506.09 / $2,550.11
| Professional | | $1,125.22 | $1,506.09 | $2,550.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.48 / $1,083.48 / $1,943.34
| Professional | | $1,083.48 | $1,083.48 | $1,943.34 |