- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.17 / $1,456.22 / $2,933.95
| Professional | | $1,326.17 | $1,456.22 | $2,933.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.40 / $1,353.40 / $2,080.00
| Professional | | $1,353.40 | $1,353.40 | $2,080.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.44 / $1,461.35 / $3,024.78
| Professional | | $1,123.44 | $1,461.35 | $3,024.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.46 / $1,576.97 / $2,621.00
| Professional | | $1,222.46 | $1,576.97 | $2,621.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.75 / $1,343.73 / $2,269.67
| Professional | | $1,009.75 | $1,343.73 | $2,269.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.28 / $961.28 / $1,719.30
| Professional | | $961.28 | $961.28 | $1,719.30 |