- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.45 / $1,665.85 / $7,985.18
| Professional | | $1,549.45 | $1,665.85 | $7,985.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.00 / $1,802.14 / $2,059.85
| Professional | | $1,640.00 | $1,802.14 | $2,059.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.45 / $2,075.23 / $4,208.76
| Professional | | $1,413.45 | $2,075.23 | $4,208.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.10 / $2,236.98 / $3,634.49
| Professional | | $1,734.10 | $2,236.98 | $3,634.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.07 / $1,954.56 / $3,909.30
| Professional | | $1,261.07 | $1,954.56 | $3,909.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.66 / $1,994.21 / $2,389.98
| Professional | | $1,326.66 | $1,994.21 | $2,389.98 |