- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.72 / $1,229.27 / $2,079.67
| Professional | | $1,018.72 | $1,229.27 | $2,079.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.94 / $1,490.14 / $2,284.83
| Professional | | $1,201.94 | $1,490.14 | $2,284.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.45 / $1,735.10 / $2,803.51
| Professional | | $1,193.45 | $1,735.10 | $2,803.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.72 / $2,174.58 / $13,311.20
| Professional | | $1,449.72 | $2,174.58 | $13,311.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.75 / $1,784.42 / $2,952.60
| Professional | | $1,304.75 | $1,784.42 | $2,952.60 |