- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.75 / $1,544.34 / $6,776.54
| Professional | | $1,290.75 | $1,544.34 | $6,776.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.90 / $1,569.21 / $1,793.61
| Professional | | $1,518.90 | $1,569.21 | $1,793.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.08 / $1,807.11 / $3,402.05
| Professional | | $1,269.08 | $1,807.11 | $3,402.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.61 / $1,824.24 / $2,933.34
| Professional | | $1,371.61 | $1,824.24 | $2,933.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.76 / $1,576.01 / $2,712.99
| Professional | | $1,165.76 | $1,576.01 | $2,712.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.14 / $1,577.35 / $1,924.22
| Professional | | $1,077.14 | $1,577.35 | $1,924.22 |