- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.23 / $1,599.35 / $3,333.58
| Professional | | $1,470.23 | $1,599.35 | $3,333.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,531.53 / $1,531.53 / $2,090.00
| Professional | | $1,531.53 | $1,531.53 | $2,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.94 / $1,639.44 / $3,297.62
| Professional | | $1,220.94 | $1,639.44 | $3,297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.95 / $1,725.96 / $2,859.16
| Professional | | $1,337.95 | $1,725.96 | $2,859.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.53 / $1,485.89 / $2,852.59
| Professional | | $1,149.53 | $1,485.89 | $2,852.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.79 / $1,086.79 / $1,875.23
| Professional | | $1,086.79 | $1,086.79 | $1,875.23 |