- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.92 / $1,817.55 / $4,434.77
| Professional | | $1,653.92 | $1,817.55 | $4,434.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.43 / $1,649.37 / $2,094.69
| Professional | | $1,484.43 | $1,649.37 | $2,094.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.35 / $1,794.27 / $3,761.93
| Professional | | $1,250.35 | $1,794.27 | $3,761.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.89 / $1,769.24 / $3,231.26
| Professional | | $1,326.89 | $1,769.24 | $3,231.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.51 / $1,662.40 / $2,972.51
| Professional | | $1,221.51 | $1,662.40 | $2,972.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.36 / $1,186.36 / $1,921.51
| Professional | | $1,186.36 | $1,186.36 | $1,921.51 |