- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.27 / $4,142.43 / $11,113.10
| Professional | | $1,092.27 | $4,142.43 | $11,113.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.62 / $2,448.44 / $3,501.70
| Professional | | $1,608.62 | $2,448.44 | $3,501.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.09 / $1,926.49 / $3,251.30
| Professional | | $1,532.09 | $1,926.49 | $3,251.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.92 / $1,600.31 / $2,786.63
| Professional | | $1,516.92 | $1,600.31 | $2,786.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.12 / $2,461.32 / $4,454.76
| Professional | | $1,489.12 | $2,461.32 | $4,454.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.73 / $2,268.69 / $4,097.21
| Professional | | $1,353.73 | $2,268.69 | $4,097.21 |