- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.82 / $1,629.28 / $7,832.74
| Professional | | $1,517.82 | $1,629.28 | $7,832.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.71 / $1,772.50 / $2,025.97
| Professional | | $1,337.71 | $1,772.50 | $2,025.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.81 / $2,087.01 / $4,122.67
| Professional | | $1,440.81 | $2,087.01 | $4,122.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,696.86 / $2,188.94 / $3,558.94
| Professional | | $1,696.86 | $2,188.94 | $3,558.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.56 / $1,849.29 / $3,236.76
| Professional | | $1,303.56 | $1,849.29 | $3,236.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.07 / $1,951.39 / $2,337.87
| Professional | | $1,424.07 | $1,951.39 | $2,337.87 |