- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.25 / $1,708.59 / $8,113.96
| Professional | | $1,620.25 | $1,708.59 | $8,113.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.00 / $1,655.46 / $1,892.20
| Professional | | $1,330.00 | $1,655.46 | $1,892.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.32 / $2,036.99 / $4,871.74
| Professional | | $1,413.32 | $2,036.99 | $4,871.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.82 / $2,206.23 / $3,542.30
| Professional | | $1,658.82 | $2,206.23 | $3,542.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.67 / $1,797.75 / $3,487.64
| Professional | | $1,304.67 | $1,797.75 | $3,487.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.48 / $1,907.64 / $2,324.92
| Professional | | $1,186.48 | $1,907.64 | $2,324.92 |