- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.28 / $1,410.11 / $3,495.73
| Professional | | $1,277.28 | $1,410.11 | $3,495.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.84 / $1,484.08 / $1,696.30
| Professional | | $1,428.84 | $1,484.08 | $1,696.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.95 / $1,673.44 / $3,849.29
| Professional | | $1,137.95 | $1,673.44 | $3,849.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.00 / $1,694.42 / $2,709.70
| Professional | | $1,274.00 | $1,694.42 | $2,709.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.33 / $1,449.03 / $2,494.40
| Professional | | $1,035.33 | $1,449.03 | $2,494.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.82 / $1,465.10 / $1,822.16
| Professional | | $987.82 | $1,465.10 | $1,822.16 |