- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.65 / $1,531.12 / $7,230.56
| Professional | | $1,444.65 | $1,531.12 | $7,230.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.19 / $1,648.19 / $1,883.88
| Professional | | $1,648.19 | $1,648.19 | $1,883.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.68 / $1,840.06 / $4,537.13
| Professional | | $1,263.68 | $1,840.06 | $4,537.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.20 / $1,972.66 / $3,166.46
| Professional | | $1,483.20 | $1,972.66 | $3,166.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.24 / $1,591.82 / $2,887.39
| Professional | | $1,169.24 | $1,591.82 | $2,887.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.61 / $1,705.68 / $2,079.69
| Professional | | $1,100.61 | $1,705.68 | $2,079.69 |