- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,570.68 / $1,597.20 / $7,083.00
| Professional | | $1,570.68 | $1,597.20 | $7,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.56 / $1,757.56 / $2,008.89
| Professional | | $1,757.56 | $1,757.56 | $2,008.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $2,339.31 / $4,232.42
| Professional | | $1,569.56 | $2,339.31 | $4,232.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.44 / $2,240.31 / $3,592.37
| Professional | | $1,684.44 | $2,240.31 | $3,592.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,507.18 / $1,978.55 / $3,405.29
| Professional | | $1,507.18 | $1,978.55 | $3,405.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.88 / $1,937.11 / $2,360.36
| Professional | | $1,552.88 | $1,937.11 | $2,360.36 |