- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.24 / $1,593.28 / $2,549.41
| Professional | | $1,177.24 | $1,593.28 | $2,549.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.71 / $2,613.82 / $10,873.20
| Professional | | $1,251.71 | $2,613.82 | $10,873.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.06 / $2,388.59 / $4,190.38
| Professional | | $1,489.06 | $2,388.59 | $4,190.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.88 / $2,062.75 / $2,812.30
| Professional | | $1,702.88 | $2,062.75 | $2,812.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.15 / $3,125.36 / $4,207.43
| Professional | | $1,497.15 | $3,125.36 | $4,207.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.39 / $3,195.80 / $10,873.20
| Professional | | $1,808.39 | $3,195.80 | $10,873.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.68 / $2,459.78 / $4,393.55
| Professional | | $1,670.68 | $2,459.78 | $4,393.55 |