- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.57 / $1,329.18 / $6,267.23
| Professional | | $1,029.57 | $1,329.18 | $6,267.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.39 / $1,678.71 / $1,955.76
| Professional | | $1,309.39 | $1,678.71 | $1,955.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.53 / $1,663.18 / $2,798.12
| Professional | | $1,160.53 | $1,663.18 | $2,798.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.77 / $1,810.95 / $10,738.32
| Professional | | $1,351.77 | $1,810.95 | $10,738.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.71 / $1,586.09 / $2,879.87
| Professional | | $1,314.71 | $1,586.09 | $2,879.87 |