- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.58 / $1,360.24 / $6,602.14
| Professional | | $1,077.58 | $1,360.24 | $6,602.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.09 / $1,756.53 / $1,984.88
| Professional | | $1,370.09 | $1,756.53 | $1,984.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.97 / $1,738.61 / $2,946.61
| Professional | | $1,211.97 | $1,738.61 | $2,946.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,394.88 / $1,859.80 / $10,902.32
| Professional | | $1,394.88 | $1,859.80 | $10,902.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,375.77 / $1,667.60 / $3,262.86
| Professional | | $1,375.77 | $1,667.60 | $3,262.86 |