- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.30 / $1,365.16 / $6,602.14
| Professional | | $1,106.30 | $1,365.16 | $6,602.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.11 / $1,583.10 / $2,120.36
| Professional | | $1,301.11 | $1,583.10 | $2,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.72 / $1,800.22 / $2,700.32
| Professional | | $1,215.72 | $1,800.22 | $2,700.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.22 / $1,379.84 / $2,317.54
| Professional | | $28.22 | $1,379.84 | $2,317.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.20 / $1,142.68 / $2,262.35
| Professional | | $19.20 | $1,142.68 | $2,262.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.23 / $1,872.74 / $2,876.95
| Professional | | $1,432.23 | $1,872.74 | $2,876.95 |