- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.51 / $1,716.04 / $2,853.11
| Professional | | $1,577.51 | $1,716.04 | $2,853.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.32 / $1,713.53 / $1,958.57
| Professional | | $1,507.32 | $1,713.53 | $1,958.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.54 / $1,630.62 / $3,536.07
| Professional | | $1,315.54 | $1,630.62 | $3,536.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.30 / $1,861.86 / $3,062.13
| Professional | | $1,443.30 | $1,861.86 | $3,062.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.74 / $1,603.58 / $2,898.47
| Professional | | $1,248.74 | $1,603.58 | $2,898.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.95 / $1,149.95 / $2,021.96
| Professional | | $1,149.95 | $1,149.95 | $2,021.96 |