- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.79 / $1,702.62 / $7,052.83
| Professional | | $1,412.79 | $1,702.62 | $7,052.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.26 / $1,628.26 / $1,861.10
| Professional | | $1,628.26 | $1,628.26 | $1,861.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.56 / $1,916.45 / $3,663.99
| Professional | | $1,343.56 | $1,916.45 | $3,663.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,486.57 / $1,977.14 / $3,054.38
| Professional | | $1,486.57 | $1,977.14 | $3,054.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.49 / $1,703.08 / $3,033.07
| Professional | | $1,216.49 | $1,703.08 | $3,033.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.30 / $1,709.56 / $2,117.28
| Professional | | $1,120.30 | $1,709.56 | $2,117.28 |