- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.69 / $1,042.69 / $6,270.76
| Professional | | $1,042.69 | $1,042.69 | $6,270.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.08 / $1,207.98 / $1,939.35
| Professional | | $866.08 | $1,207.98 | $1,939.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.67 / $914.59 / $1,222.24
| Professional | | $94.67 | $914.59 | $1,222.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.20 / $1,778.09 / $2,008.95
| Professional | | $1,598.20 | $1,778.09 | $2,008.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.18 / $1,303.21 / $1,797.15
| Professional | | $1,089.18 | $1,303.21 | $1,797.15 |