- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.88 / $1,249.14 / $3,347.69
| Professional | | $1,175.88 | $1,249.14 | $3,347.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.57 / $1,329.89 / $1,520.06
| Professional | | $1,328.57 | $1,329.89 | $1,520.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.54 / $1,544.18 / $3,578.21
| Professional | | $1,121.54 | $1,544.18 | $3,578.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.31 / $1,575.13 / $2,518.21
| Professional | | $1,184.31 | $1,575.13 | $2,518.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.34 / $1,361.43 / $2,340.57
| Professional | | $988.34 | $1,361.43 | $2,340.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.71 / $1,361.96 / $1,694.21
| Professional | | $922.71 | $1,361.96 | $1,694.21 |