- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.57 / $1,718.65 / $7,512.38
| Professional | | $1,430.57 | $1,718.65 | $7,512.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.78 / $1,752.78 / $2,240.00
| Professional | | $1,752.78 | $1,752.78 | $2,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.50 / $2,073.64 / $3,775.64
| Professional | | $1,397.50 | $2,073.64 | $3,775.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.38 / $2,030.09 / $3,259.02
| Professional | | $1,526.38 | $2,030.09 | $3,259.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.11 / $1,779.15 / $3,341.27
| Professional | | $1,295.11 | $1,779.15 | $3,341.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,188.38 / $1,755.34 / $2,141.90
| Professional | | $1,188.38 | $1,755.34 | $2,141.90 |