- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.25 / $1,484.15 / $2,672.76
| Professional | | $1,362.25 | $1,484.15 | $2,672.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.28 / $1,406.93 / $1,608.12
| Professional | | $1,315.28 | $1,406.93 | $1,608.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.06 / $1,389.60 / $3,056.26
| Professional | | $1,138.06 | $1,389.60 | $3,056.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.56 / $1,610.64 / $2,644.70
| Professional | | $1,248.56 | $1,610.64 | $2,644.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.91 / $1,366.58 / $2,500.84
| Professional | | $1,031.91 | $1,366.58 | $2,500.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.43 / $992.43 / $1,749.12
| Professional | | $992.43 | $992.43 | $1,749.12 |