- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.61 / $1,506.23 / $3,151.04
| Professional | | $1,372.61 | $1,506.23 | $3,151.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.90 / $1,594.35 / $2,500.00
| Professional | | $1,533.90 | $1,594.35 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.68 / $1,783.87 / $4,135.30
| Professional | | $1,295.68 | $1,783.87 | $4,135.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.51 / $1,820.12 / $2,910.88
| Professional | | $1,368.51 | $1,820.12 | $2,910.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.08 / $1,484.30 / $2,682.87
| Professional | | $1,149.08 | $1,484.30 | $2,682.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.09 / $1,573.79 / $1,957.41
| Professional | | $1,062.09 | $1,573.79 | $1,957.41 |