- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.80 / $1,151.03 / $2,421.92
| Professional | | $1,031.80 | $1,151.03 | $2,421.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.32 / $1,368.36 / $1,710.45
| Professional | | $1,197.32 | $1,368.36 | $1,710.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.45 / $1,458.17 / $2,336.98
| Professional | | $1,036.45 | $1,458.17 | $2,336.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.54 / $1,320.48 / $9,976.00
| Professional | | $1,060.54 | $1,320.48 | $9,976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.75 / $1,251.95 / $2,428.31
| Professional | | $1,051.75 | $1,251.95 | $2,428.31 |