- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.43 / $1,293.38 / $2,130.02
| Professional | | $1,013.43 | $1,293.38 | $2,130.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.02 / $1,589.49 / $2,526.00
| Professional | | $1,297.02 | $1,589.49 | $2,526.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.27 / $1,845.75 / $2,987.56
| Professional | | $1,269.27 | $1,845.75 | $2,987.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.56 / $2,309.96 / $10,738.32
| Professional | | $1,530.56 | $2,309.96 | $10,738.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.45 / $1,920.85 / $3,035.59
| Professional | | $1,425.45 | $1,920.85 | $3,035.59 |