- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.87 / $1,721.98 / $4,786.32
| Professional | | $1,509.87 | $1,721.98 | $4,786.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.31 / $1,803.89 / $2,061.85
| Professional | | $1,682.31 | $1,803.89 | $2,061.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.77 / $1,724.49 / $3,562.92
| Professional | | $1,325.77 | $1,724.49 | $3,562.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.69 / $1,868.81 / $3,095.58
| Professional | | $1,448.69 | $1,868.81 | $3,095.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.30 / $1,616.91 / $2,856.81
| Professional | | $1,232.30 | $1,616.91 | $2,856.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.44 / $1,136.44 / $2,032.53
| Professional | | $1,136.44 | $1,136.44 | $2,032.53 |