- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.00 / $1,501.27 / $2,440.88
| Professional | | $1,123.00 | $1,501.27 | $2,440.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.05 / $2,028.80 / $3,100.09
| Professional | | $1,426.05 | $2,028.80 | $3,100.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.96 / $2,066.56 / $3,310.02
| Professional | | $1,437.96 | $2,066.56 | $3,310.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,979.52 / $11,382.08 / $12,952.05
| Professional | | $8,979.52 | $11,382.08 | $12,952.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.04 / $1,924.99 / $3,457.81
| Professional | | $1,379.04 | $1,924.99 | $3,457.81 |