- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.49 / $1,423.16 / $3,984.12
| Professional | | $1,363.49 | $1,423.16 | $3,984.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.84 / $1,349.71 / $1,542.72
| Professional | | $1,347.84 | $1,349.71 | $1,542.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.20 / $1,462.49 / $2,932.35
| Professional | | $1,091.20 | $1,462.49 | $2,932.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.93 / $1,544.04 / $2,542.42
| Professional | | $1,196.93 | $1,544.04 | $2,542.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.14 / $1,382.29 / $2,498.48
| Professional | | $1,029.14 | $1,382.29 | $2,498.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.78 / $986.78 / $1,676.94
| Professional | | $986.78 | $986.78 | $1,676.94 |