- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.09 / $1,443.19 / $2,233.15
| Professional | | $1,140.09 | $1,443.19 | $2,233.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.85 / $2,179.61 / $4,542.54
| Professional | | $1,265.85 | $2,179.61 | $4,542.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.85 / $2,284.01 / $2,756.22
| Professional | | $1,723.85 | $2,284.01 | $2,756.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.84 / $1,534.71 / $3,424.77
| Professional | | $998.84 | $1,534.71 | $3,424.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.89 / $2,033.10 / $4,595.64
| Professional | | $1,259.89 | $2,033.10 | $4,595.64 |