- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.59 / $1,465.78 / $8,930.48
| Professional | | $1,443.59 | $1,465.78 | $8,930.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.00 / $1,958.89 / $2,239.01
| Professional | | $1,670.00 | $1,958.89 | $2,239.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.76 / $2,184.67 / $4,441.81
| Professional | | $1,529.76 | $2,184.67 | $4,441.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.89 / $2,401.83 / $3,840.33
| Professional | | $1,805.89 | $2,401.83 | $3,840.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.77 / $1,957.53 / $3,457.28
| Professional | | $1,321.77 | $1,957.53 | $3,457.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.75 / $2,076.77 / $2,562.77
| Professional | | $1,550.75 | $2,076.77 | $2,562.77 |