- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.56 / $1,339.11 / $2,132.32
| Professional | | $1,116.56 | $1,339.11 | $2,132.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.63 / $1,685.45 / $2,028.93
| Professional | | $1,432.63 | $1,685.45 | $2,028.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.90 / $1,748.05 / $2,745.84
| Professional | | $1,317.90 | $1,748.05 | $2,745.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.71 / $1,909.85 / $13,311.20
| Professional | | $1,514.71 | $1,909.85 | $13,311.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.72 / $1,712.28 / $2,427.28
| Professional | | $1,449.72 | $1,712.28 | $2,427.28 |