- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.72 / $1,526.74 / $2,516.14
| Professional | | $1,094.72 | $1,526.74 | $2,516.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.45 / $1,809.23 / $2,131.89
| Professional | | $1,346.45 | $1,809.23 | $2,131.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,854.67 / $2,023.27 / $2,729.17
| Professional | | $1,854.67 | $2,023.27 | $2,729.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,622.46 / $2,041.16
| Professional | | $32.34 | $1,622.46 | $2,041.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.98 / $2,294.09 / $2,729.18
| Professional | | $1,949.98 | $2,294.09 | $2,729.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.52 / $1,803.88 / $2,567.06
| Professional | | $1,316.52 | $1,803.88 | $2,567.06 |