- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.84 / $1,246.94 / $5,762.91
| Professional | | $1,067.84 | $1,246.94 | $5,762.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.58 / $1,310.73 / $1,498.16
| Professional | | $1,263.58 | $1,310.73 | $1,498.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.03 / $1,454.62 / $3,399.64
| Professional | | $1,054.03 | $1,454.62 | $3,399.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.48 / $1,496.89 / $2,393.87
| Professional | | $1,125.48 | $1,496.89 | $2,393.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.27 / $1,281.83 / $2,608.56
| Professional | | $956.27 | $1,281.83 | $2,608.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.01 / $1,294.30 / $1,609.56
| Professional | | $874.01 | $1,294.30 | $1,609.56 |