- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.45 / $1,330.67 / $6,309.71
| Professional | | $1,259.45 | $1,330.67 | $6,309.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.00 / $1,440.26 / $1,646.21
| Professional | | $1,430.00 | $1,440.26 | $1,646.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.57 / $1,615.08 / $3,945.72
| Professional | | $1,100.57 | $1,615.08 | $3,945.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.75 / $1,718.03 / $2,757.02
| Professional | | $1,291.75 | $1,718.03 | $2,757.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.39 / $1,465.28 / $2,522.37
| Professional | | $1,037.39 | $1,465.28 | $2,522.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.47 / $1,485.51 / $1,810.88
| Professional | | $979.47 | $1,485.51 | $1,810.88 |