- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.16 / $1,262.32 / $5,976.25
| Professional | | $1,192.16 | $1,262.32 | $5,976.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.41 / $1,130.09 / $1,291.64
| Professional | | $1,094.41 | $1,130.09 | $1,291.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.57 / $1,505.44 / $3,552.70
| Professional | | $1,042.57 | $1,505.44 | $3,552.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.67 / $1,627.48 / $2,610.62
| Professional | | $1,223.67 | $1,627.48 | $2,610.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.55 / $1,284.77 / $2,563.26
| Professional | | $1,004.55 | $1,284.77 | $2,563.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.18 / $1,407.22 / $1,715.63
| Professional | | $820.18 | $1,407.22 | $1,715.63 |