- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.24 / $1,396.15 / $1,901.61
| Professional | | $1,133.24 | $1,396.15 | $1,901.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.13 / $1,778.89 / $2,981.94
| Professional | | $1,090.13 | $1,778.89 | $2,981.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.18 / $1,438.91 / $1,806.58
| Professional | | $710.18 | $1,438.91 | $1,806.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.90 / $1,054.88 / $1,839.45
| Professional | | $144.90 | $1,054.88 | $1,839.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.02 / $1,698.86 / $2,901.30
| Professional | | $1,172.02 | $1,698.86 | $2,901.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.49 / $1,141.30 / $1,141.30
| Professional | | $910.49 | $1,141.30 | $1,141.30 |