- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.83 / $1,388.29 / $2,825.73
| Professional | | $1,269.83 | $1,388.29 | $2,825.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.94 / $1,333.49 / $1,747.80
| Professional | | $1,326.94 | $1,333.49 | $1,747.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.60 / $1,419.02 / $2,857.31
| Professional | | $1,063.60 | $1,419.02 | $2,857.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.32 / $1,504.55 / $2,471.85
| Professional | | $1,166.32 | $1,504.55 | $2,471.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.15 / $1,393.29 / $2,329.76
| Professional | | $1,031.15 | $1,393.29 | $2,329.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.10 / $931.10 / $1,634.19
| Professional | | $931.10 | $931.10 | $1,634.19 |