- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.13 / $1,465.90 / $4,315.70
| Professional | | $1,346.13 | $1,465.90 | $4,315.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.33 / $1,462.36 / $1,671.49
| Professional | | $1,289.33 | $1,462.36 | $1,671.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.45 / $1,558.97 / $3,018.86
| Professional | | $1,124.45 | $1,558.97 | $3,018.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.57 / $1,591.31 / $2,613.71
| Professional | | $1,233.57 | $1,591.31 | $2,613.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.09 / $1,391.27 / $2,472.03
| Professional | | $1,011.09 | $1,391.27 | $2,472.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.18 / $1,122.18 / $1,728.15
| Professional | | $1,122.18 | $1,122.18 | $1,728.15 |