- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.40 / $1,471.40 / $1,506.39
| Professional | | $1,471.40 | $1,471.40 | $1,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.16 / $1,752.16 / $4,674.22
| Professional | | $1,752.16 | $1,752.16 | $4,674.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.52 / $1,753.38 / $2,962.18
| Professional | | $1,453.52 | $1,753.38 | $2,962.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.66 / $1,843.96 / $2,962.18
| Professional | | $1,379.66 | $1,843.96 | $2,962.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.69 / $1,860.50 / $5,408.61
| Professional | | $1,540.69 | $1,860.50 | $5,408.61 |