- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.65 / $1,277.83 / $6,294.92
| Professional | | $1,221.65 | $1,277.83 | $6,294.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.22 / $1,442.21 / $1,648.45
| Professional | | $1,397.22 | $1,442.21 | $1,648.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.30 / $1,592.03 / $3,740.66
| Professional | | $1,154.30 | $1,592.03 | $3,740.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.92 / $1,617.17 / $2,624.51
| Professional | | $1,215.92 | $1,617.17 | $2,624.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.28 / $1,545.88 / $2,830.25
| Professional | | $1,050.28 | $1,545.88 | $2,830.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.91 / $1,398.31 / $1,739.25
| Professional | | $957.91 | $1,398.31 | $1,739.25 |