- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.61 / $1,605.97 / $4,182.43
| Professional | | $1,560.61 | $1,605.97 | $4,182.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.29 / $1,910.28 / $2,183.44
| Professional | | $1,848.29 | $1,910.28 | $2,183.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.92 / $2,055.21 / $4,058.27
| Professional | | $1,420.92 | $2,055.21 | $4,058.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.77 / $2,222.12 / $3,502.73
| Professional | | $1,670.77 | $2,222.12 | $3,502.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.13 / $1,749.81 / $3,174.11
| Professional | | $1,292.13 | $1,749.81 | $3,174.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.62 / $1,921.39 / $2,303.25
| Professional | | $1,399.62 | $1,921.39 | $2,303.25 |