- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.57 / $1,521.76 / $3,233.94
| Professional | | $1,393.57 | $1,521.76 | $3,233.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.30 / $1,436.12 / $1,641.49
| Professional | | $1,403.30 | $1,436.12 | $1,641.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.10 / $1,555.48 / $3,131.67
| Professional | | $1,165.10 | $1,555.48 | $3,131.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.83 / $1,648.40 / $2,708.16
| Professional | | $1,277.83 | $1,648.40 | $2,708.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.42 / $1,437.18 / $2,553.35
| Professional | | $1,107.42 | $1,437.18 | $2,553.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.79 / $1,013.79 / $1,790.32
| Professional | | $1,013.79 | $1,013.79 | $1,790.32 |