- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.03 / $1,560.56 / $4,133.95
| Professional | | $1,419.03 | $1,560.56 | $4,133.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.07 / $1,404.07 / $1,658.50
| Professional | | $1,404.07 | $1,404.07 | $1,658.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.33 / $1,537.79 / $3,206.97
| Professional | | $1,190.33 | $1,537.79 | $3,206.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.53 / $1,671.23 / $2,778.23
| Professional | | $1,295.53 | $1,671.23 | $2,778.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.44 / $1,422.55 / $2,759.75
| Professional | | $1,061.44 | $1,422.55 | $2,759.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.93 / $1,006.93 / $1,821.88
| Professional | | $1,006.93 | $1,006.93 | $1,821.88 |