- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.28 / $1,645.73 / $5,711.58
| Professional | | $1,374.28 | $1,645.73 | $5,711.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.67 / $1,495.19 / $1,898.89
| Professional | | $1,406.67 | $1,495.19 | $1,898.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.43 / $1,567.50 / $3,425.84
| Professional | | $1,229.43 | $1,567.50 | $3,425.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.68 / $1,694.65 / $2,859.34
| Professional | | $1,313.68 | $1,694.65 | $2,859.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.11 / $1,536.94 / $2,779.41
| Professional | | $1,138.11 | $1,536.94 | $2,779.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.98 / $1,130.98 / $1,867.92
| Professional | | $1,130.98 | $1,130.98 | $1,867.92 |