- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.07 / $1,480.37 / $6,886.34
| Professional | | $1,275.07 | $1,480.37 | $6,886.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.26 / $1,559.31 / $1,782.29
| Professional | | $1,500.26 | $1,559.31 | $1,782.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.58 / $1,755.04 / $4,044.42
| Professional | | $1,278.58 | $1,755.04 | $4,044.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.68 / $1,780.44 / $2,851.73
| Professional | | $1,338.68 | $1,780.44 | $2,851.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.00 / $1,599.58 / $3,503.08
| Professional | | $1,126.00 | $1,599.58 | $3,503.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.13 / $1,539.48 / $1,915.17
| Professional | | $1,043.13 | $1,539.48 | $1,915.17 |