- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.59 / $1,618.49 / $2,979.30
| Professional | | $1,473.59 | $1,618.49 | $2,979.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.05 / $1,625.14 / $1,857.54
| Professional | | $1,423.05 | $1,625.14 | $1,857.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.65 / $1,571.25 / $3,327.97
| Professional | | $1,241.65 | $1,571.25 | $3,327.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.87 / $1,756.81 / $2,879.61
| Professional | | $1,361.87 | $1,756.81 | $2,879.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.41 / $1,571.32 / $2,548.06
| Professional | | $1,161.41 | $1,571.32 | $2,548.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.71 / $1,089.71 / $1,907.99
| Professional | | $1,089.71 | $1,089.71 | $1,907.99 |