- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.72 / $2,074.57 / $8,093.94
| Professional | | $1,215.72 | $2,074.57 | $8,093.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.41 / $1,832.41 / $2,289.33
| Professional | | $1,832.41 | $1,832.41 | $2,289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.47 / $1,945.93 / $2,813.76
| Professional | | $1,149.47 | $1,945.93 | $2,813.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.75 / $2,064.46 / $2,961.75
| Professional | | $1,351.75 | $2,064.46 | $2,961.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.84 / $2,571.82 / $2,830.41
| Professional | | $2,133.84 | $2,571.82 | $2,830.41 |