- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.36 / $1,456.32 / $2,320.84
| Professional | | $1,179.36 | $1,456.32 | $2,320.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.37 / $2,042.79 / $2,477.19
| Professional | | $1,736.37 | $2,042.79 | $2,477.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.49 / $1,930.87 / $3,033.75
| Professional | | $1,455.49 | $1,930.87 | $3,033.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.58 / $2,237.69 / $10,902.32
| Professional | | $1,700.58 | $2,237.69 | $10,902.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.81 / $1,884.30 / $2,638.94
| Professional | | $1,651.81 | $1,884.30 | $2,638.94 |