- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.16 / $1,303.13 / $6,469.67
| Professional | | $1,249.16 | $1,303.13 | $6,469.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,411.37 / $1,411.37 / $1,613.19
| Professional | | $1,411.37 | $1,411.37 | $1,613.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.92 / $1,650.46 / $3,817.15
| Professional | | $1,190.92 | $1,650.46 | $3,817.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.65 / $1,681.98 / $2,687.91
| Professional | | $1,264.65 | $1,681.98 | $2,687.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.86 / $1,398.93 / $2,470.56
| Professional | | $1,057.86 | $1,398.93 | $2,470.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.59 / $1,454.35 / $1,808.51
| Professional | | $980.59 | $1,454.35 | $1,808.51 |