- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.56 / $1,362.90 / $2,440.75
| Professional | | $1,237.56 | $1,362.90 | $2,440.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.07 / $1,465.89 / $1,675.51
| Professional | | $1,198.07 | $1,465.89 | $1,675.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.07 / $1,487.96 / $2,806.86
| Professional | | $1,045.07 | $1,487.96 | $2,806.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.43 / $1,478.89 / $2,431.08
| Professional | | $1,146.43 | $1,478.89 | $2,431.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.85 / $1,374.29 / $2,297.77
| Professional | | $1,027.85 | $1,374.29 | $2,297.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.75 / $994.75 / $1,606.13
| Professional | | $994.75 | $994.75 | $1,606.13 |