- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.98 / $2,554.17 / $2,556.33
| Professional | | $2,321.98 | $2,554.17 | $2,556.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.76 / $1,388.31 / $1,763.15
| Professional | | $895.76 | $1,388.31 | $1,763.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.14 / $1,932.93 / $3,235.52
| Professional | | $1,107.14 | $1,932.93 | $3,235.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.51 / $1,618.32 / $2,717.60
| Professional | | $1,254.51 | $1,618.32 | $2,717.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.69 / $1,219.69 / $2,039.64
| Professional | | $785.69 | $1,219.69 | $2,039.64 |