- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.67 / $1,217.54 / $6,064.54
| Professional | | $1,168.67 | $1,217.54 | $6,064.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.96 / $1,322.96 / $1,512.14
| Professional | | $1,322.96 | $1,322.96 | $1,512.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.46 / $1,541.03 / $3,567.25
| Professional | | $1,124.46 | $1,541.03 | $3,567.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.97 / $1,572.02 / $2,513.89
| Professional | | $1,181.97 | $1,572.02 | $2,513.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.76 / $1,475.11 / $2,782.62
| Professional | | $1,005.76 | $1,475.11 | $2,782.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.52 / $1,359.27 / $1,690.76
| Professional | | $912.52 | $1,359.27 | $1,690.76 |