- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.24 / $1,050.85 / $2,088.61
| Professional | | $1,030.24 | $1,050.85 | $2,088.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.26 / $1,521.10 / $1,738.62
| Professional | | $1,445.26 | $1,521.10 | $1,738.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.29 / $1,676.54 / $3,183.84
| Professional | | $1,135.29 | $1,676.54 | $3,183.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.13 / $1,655.24 / $2,759.41
| Professional | | $1,283.13 | $1,655.24 | $2,759.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.66 / $1,510.35 / $3,059.60
| Professional | | $1,102.66 | $1,510.35 | $3,059.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.53 / $1,475.60 / $1,821.44
| Professional | | $1,197.53 | $1,475.60 | $1,821.44 |