- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.50 / $1,098.21 / $6,686.45
| Professional | | $1,083.50 | $1,098.21 | $6,686.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.82 / $1,505.82 / $2,140.00
| Professional | | $1,505.82 | $1,505.82 | $2,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.33 / $1,670.74 / $3,326.11
| Professional | | $1,119.33 | $1,670.74 | $3,326.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.68 / $1,801.72 / $2,878.54
| Professional | | $1,354.68 | $1,801.72 | $2,878.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.29 / $1,439.40 / $2,585.76
| Professional | | $1,052.29 | $1,439.40 | $2,585.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.11 / $1,557.88 / $1,922.16
| Professional | | $1,137.11 | $1,557.88 | $1,922.16 |