- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.66 / $1,732.64 / $1,984.69
| Professional | | $1,334.66 | $1,732.64 | $1,984.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.72 / $1,642.72 / $2,099.81
| Professional | | $1,642.72 | $1,642.72 | $2,099.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.88 / $1,768.43 / $3,711.54
| Professional | | $1,381.88 | $1,768.43 | $3,711.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.53 / $1,947.29 / $3,223.74
| Professional | | $1,509.53 | $1,947.29 | $3,223.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.63 / $1,736.39 / $3,470.53
| Professional | | $1,263.63 | $1,736.39 | $3,470.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.97 / $1,183.97 / $2,118.21
| Professional | | $1,183.97 | $1,183.97 | $2,118.21 |