- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.11 / $1,472.50 / $7,239.33
| Professional | | $1,424.11 | $1,472.50 | $7,239.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.42 / $1,677.61 / $1,917.51
| Professional | | $1,615.42 | $1,677.61 | $1,917.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.09 / $1,978.97 / $3,683.22
| Professional | | $1,304.09 | $1,978.97 | $3,683.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.35 / $2,011.43 / $3,122.29
| Professional | | $1,512.35 | $2,011.43 | $3,122.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.06 / $1,772.53 / $3,450.76
| Professional | | $1,271.06 | $1,772.53 | $3,450.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.88 / $1,739.20 / $2,117.37
| Professional | | $1,385.88 | $1,739.20 | $2,117.37 |