- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.83 / $1,275.74 / $6,353.98
| Professional | | $1,224.83 | $1,275.74 | $6,353.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.67 / $1,441.15 / $1,647.23
| Professional | | $1,387.67 | $1,441.15 | $1,647.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.16 / $1,604.85 / $3,737.92
| Professional | | $1,142.16 | $1,604.85 | $3,737.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.29 / $1,645.60 / $2,633.57
| Professional | | $1,237.29 | $1,645.60 | $2,633.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.93 / $1,366.17 / $2,503.32
| Professional | | $1,046.93 | $1,366.17 | $2,503.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.55 / $1,422.88 / $1,770.17
| Professional | | $962.55 | $1,422.88 | $1,770.17 |