- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,357.05 / $2,357.05 / $3,416.40
| Professional | | $2,357.05 | $2,357.05 | $3,416.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.21 / $2,005.85 / $2,369.92
| Professional | | $1,798.21 | $2,005.85 | $2,369.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.87 / $1,807.33 / $2,487.53
| Professional | | $1,445.87 | $1,807.33 | $2,487.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.74 / $2,047.14 / $6,302.04
| Professional | | $1,064.74 | $2,047.14 | $6,302.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.33 / $1,853.36 / $2,692.24
| Professional | | $1,069.33 | $1,853.36 | $2,692.24 |