- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.99 / $1,153.41 / $1,527.03
| Professional | | $1,016.99 | $1,153.41 | $1,527.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.16 / $1,514.01 / $2,480.17
| Professional | | $959.16 | $1,514.01 | $2,480.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.23 / $1,074.53 / $1,350.63
| Professional | | $565.23 | $1,074.53 | $1,350.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.01 / $809.30 / $1,421.73
| Professional | | $108.01 | $809.30 | $1,421.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.22 / $1,264.86 / $2,281.98
| Professional | | $879.22 | $1,264.86 | $2,281.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.25 / $887.25 / $1,131.08
| Professional | | $887.25 | $887.25 | $1,131.08 |