- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.24 / $1,494.06 / $1,901.61
| Professional | | $1,133.24 | $1,494.06 | $1,901.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.95 / $1,165.35 / $2,219.75
| Professional | | $313.95 | $1,165.35 | $2,219.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.63 / $1,709.37 / $2,589.03
| Professional | | $1,061.63 | $1,709.37 | $2,589.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.60 / $1,664.30 / $2,375.46
| Professional | | $1,450.60 | $1,664.30 | $2,375.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.00 / $997.29 / $1,681.37
| Professional | | $137.00 | $997.29 | $1,681.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.87 / $1,947.58 / $2,694.58
| Professional | | $1,597.87 | $1,947.58 | $2,694.58 |