- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.31 / $1,567.41 / $4,368.97
| Professional | | $1,258.31 | $1,567.41 | $4,368.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.93 / $1,693.97 / $1,936.22
| Professional | | $1,532.93 | $1,693.97 | $1,936.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.33 / $1,614.50 / $3,243.60
| Professional | | $1,208.33 | $1,614.50 | $3,243.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.24 / $1,703.11 / $2,817.54
| Professional | | $1,320.24 | $1,703.11 | $2,817.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,132.98 / $1,581.05 / $3,032.75
| Professional | | $1,132.98 | $1,581.05 | $3,032.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.05 / $1,081.05 / $1,852.32
| Professional | | $1,081.05 | $1,081.05 | $1,852.32 |