- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.93 / $1,424.91 / $2,269.80
| Professional | | $1,120.93 | $1,424.91 | $2,269.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.43 / $1,905.21 / $2,324.34
| Professional | | $1,619.43 | $1,905.21 | $2,324.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.90 / $1,878.55 / $2,959.43
| Professional | | $1,379.90 | $1,878.55 | $2,959.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.03 / $2,104.40 / $10,738.32
| Professional | | $1,615.03 | $2,104.40 | $10,738.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.48 / $1,857.15 / $2,548.55
| Professional | | $1,576.48 | $1,857.15 | $2,548.55 |