- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.73 / $1,571.72 / $3,426.65
| Professional | | $1,122.73 | $1,571.72 | $3,426.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.19 / $2,222.82 / $3,433.02
| Professional | | $1,150.19 | $2,222.82 | $3,433.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.95 / $2,534.65 / $3,437.29
| Professional | | $1,713.95 | $2,534.65 | $3,437.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.34 / $2,307.58 / $2,882.96
| Professional | | $1,249.34 | $2,307.58 | $2,882.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.45 / $2,394.21 / $4,338.89
| Professional | | $1,292.45 | $2,394.21 | $4,338.89 |