- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.71 / $1,593.38 / $7,653.96
| Professional | | $1,481.71 | $1,593.38 | $7,653.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.48 / $1,727.48 / $1,974.51
| Professional | | $1,727.48 | $1,727.48 | $1,974.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.73 / $2,040.26 / $4,024.67
| Professional | | $1,417.73 | $2,040.26 | $4,024.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.35 / $2,183.44 / $3,476.05
| Professional | | $1,659.35 | $2,183.44 | $3,476.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.08 / $1,787.83 / $3,390.09
| Professional | | $1,246.08 | $1,787.83 | $3,390.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.71 / $1,908.25 / $2,286.92
| Professional | | $1,396.71 | $1,908.25 | $2,286.92 |