- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.51 / $1,627.64 / $7,125.14
| Professional | | $1,359.51 | $1,627.64 | $7,125.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.62 / $1,645.17 / $1,880.44
| Professional | | $1,601.62 | $1,645.17 | $1,880.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.84 / $1,862.08 / $3,584.75
| Professional | | $1,309.84 | $1,862.08 | $3,584.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.81 / $1,921.60 / $3,091.09
| Professional | | $1,444.81 | $1,921.60 | $3,091.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.13 / $1,661.15 / $3,393.19
| Professional | | $1,212.13 | $1,661.15 | $3,393.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.10 / $1,661.53 / $2,027.00
| Professional | | $1,014.10 | $1,661.53 | $2,027.00 |