- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,476.21 / $1,535.90 / $7,660.09
| Professional | | $1,476.21 | $1,535.90 | $7,660.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.31 / $1,735.97 / $1,984.21
| Professional | | $1,671.31 | $1,735.97 | $1,984.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.37 / $1,943.19 / $4,502.59
| Professional | | $1,420.37 | $1,943.19 | $4,502.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.43 / $1,982.27 / $3,171.13
| Professional | | $1,490.43 | $1,982.27 | $3,171.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.95 / $1,768.62 / $2,927.50
| Professional | | $1,269.95 | $1,768.62 | $2,927.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.71 / $1,713.99 / $2,132.30
| Professional | | $1,161.71 | $1,713.99 | $2,132.30 |