- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.38 / $1,285.41 / $6,150.35
| Professional | | $1,189.38 | $1,285.41 | $6,150.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.37 / $1,393.37 / $1,592.62
| Professional | | $1,393.37 | $1,393.37 | $1,592.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.70 / $1,641.75 / $3,231.60
| Professional | | $1,110.70 | $1,641.75 | $3,231.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.79 / $1,725.75 / $2,800.26
| Professional | | $1,337.79 | $1,725.75 | $2,800.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.18 / $1,497.89 / $2,709.25
| Professional | | $1,028.18 | $1,497.89 | $2,709.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.52 / $1,538.46 / $1,846.11
| Professional | | $1,097.52 | $1,538.46 | $1,846.11 |