- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.41 / $1,537.47 / $2,483.26
| Professional | | $1,397.41 | $1,537.47 | $2,483.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.95 / $1,348.95 / $1,632.23
| Professional | | $1,348.95 | $1,348.95 | $1,632.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.70 / $1,490.18 / $3,175.04
| Professional | | $1,174.70 | $1,490.18 | $3,175.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.24 / $1,665.29 / $2,773.34
| Professional | | $1,283.24 | $1,665.29 | $2,773.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.57 / $1,391.74 / $2,558.32
| Professional | | $1,036.57 | $1,391.74 | $2,558.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.42 / $1,000.42 / $1,827.45
| Professional | | $1,000.42 | $1,000.42 | $1,827.45 |