- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.15 / $1,764.35 / $8,435.67
| Professional | | $1,636.15 | $1,764.35 | $8,435.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.01 / $1,818.48 / $2,078.52
| Professional | | $1,387.01 | $1,818.48 | $2,078.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,366.28 / $2,005.88 / $4,445.01
| Professional | | $1,366.28 | $2,005.88 | $4,445.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,834.77 / $2,366.85 / $3,844.98
| Professional | | $1,834.77 | $2,366.85 | $3,844.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.21 / $1,845.24 / $3,469.24
| Professional | | $1,154.21 | $1,845.24 | $3,469.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.45 / $2,109.98 / $2,530.89
| Professional | | $1,282.45 | $2,109.98 | $2,530.89 |