- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.14 / $1,484.40 / $2,643.25
| Professional | | $1,360.14 | $1,484.40 | $2,643.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.41 / $1,535.51 / $1,755.09
| Professional | | $1,305.41 | $1,535.51 | $1,755.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.09 / $1,524.17 / $3,056.03
| Professional | | $1,138.09 | $1,524.17 | $3,056.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.22 / $1,610.20 / $2,642.89
| Professional | | $1,248.22 | $1,610.20 | $2,642.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.08 / $1,403.03 / $2,336.94
| Professional | | $1,066.08 | $1,403.03 | $2,336.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.87 / $1,019.87 / $1,748.84
| Professional | | $1,019.87 | $1,019.87 | $1,748.84 |