- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.80 / $1,787.58 / $2,812.59
| Professional | | $1,624.80 | $1,787.58 | $2,812.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.23 / $1,679.82 / $1,920.04
| Professional | | $1,638.23 | $1,679.82 | $1,920.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.14 / $1,803.24 / $3,651.63
| Professional | | $1,350.14 | $1,803.24 | $3,651.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.72 / $1,907.55 / $3,164.82
| Professional | | $1,478.72 | $1,907.55 | $3,164.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.06 / $1,649.53 / $2,792.98
| Professional | | $1,272.06 | $1,649.53 | $2,792.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.30 / $1,183.30 / $2,073.13
| Professional | | $1,183.30 | $1,183.30 | $2,073.13 |