- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.50 / $1,507.18 / $3,483.25
| Professional | | $1,384.50 | $1,507.18 | $3,483.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.33 / $1,430.80 / $1,731.27
| Professional | | $1,370.33 | $1,430.80 | $1,731.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.93 / $1,548.88 / $3,104.34
| Professional | | $1,154.93 | $1,548.88 | $3,104.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.89 / $1,634.29 / $2,687.53
| Professional | | $1,266.89 | $1,634.29 | $2,687.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.33 / $1,477.05 / $2,542.63
| Professional | | $1,052.33 | $1,477.05 | $2,542.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.06 / $1,009.06 / $1,774.98
| Professional | | $1,009.06 | $1,009.06 | $1,774.98 |