- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.32 / $1,270.01 / $1,460.51
| Professional | | $1,028.32 | $1,270.01 | $1,460.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.81 / $1,418.81 / $1,621.70
| Professional | | $1,418.81 | $1,418.81 | $1,621.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.68 / $1,672.95 / $3,298.77
| Professional | | $1,121.68 | $1,672.95 | $3,298.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.67 / $1,755.63 / $2,853.49
| Professional | | $1,360.67 | $1,755.63 | $2,853.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.77 / $1,395.81 / $2,559.35
| Professional | | $1,009.77 | $1,395.81 | $2,559.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.47 / $1,564.77 / $1,876.27
| Professional | | $1,112.47 | $1,564.77 | $1,876.27 |