- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.83 / $1,525.53 / $2,678.63
| Professional | | $1,426.83 | $1,525.53 | $2,678.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.40 / $1,402.78 / $1,729.36
| Professional | | $1,377.40 | $1,402.78 | $1,729.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.29 / $1,613.66 / $3,162.33
| Professional | | $1,204.29 | $1,613.66 | $3,162.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.43 / $1,667.23 / $2,755.08
| Professional | | $1,292.43 | $1,667.23 | $2,755.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.18 / $1,545.94 / $3,358.18
| Professional | | $1,114.18 | $1,545.94 | $3,358.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.79 / $1,005.79 / $1,849.08
| Professional | | $1,005.79 | $1,005.79 | $1,849.08 |