- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.22 / $1,329.69 / $6,377.39
| Professional | | $1,235.22 | $1,329.69 | $6,377.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.84 / $1,441.84 / $1,900.00
| Professional | | $1,441.84 | $1,441.84 | $1,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.23 / $1,687.31 / $3,355.67
| Professional | | $1,128.23 | $1,687.31 | $3,355.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.82 / $1,840.48 / $2,899.95
| Professional | | $1,383.82 | $1,840.48 | $2,899.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.30 / $1,476.40 / $2,627.04
| Professional | | $986.30 | $1,476.40 | $2,627.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.64 / $1,591.39 / $1,907.94
| Professional | | $1,065.64 | $1,591.39 | $1,907.94 |