- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.38 / $1,906.54 / $3,186.67
| Professional | | $1,301.38 | $1,906.54 | $3,186.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.28 / $2,150.02 / $2,918.00
| Professional | | $1,691.28 | $2,150.02 | $2,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.95 / $2,499.40 / $3,119.12
| Professional | | $1,961.95 | $2,499.40 | $3,119.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $2,187.33 / $2,469.57
| Professional | | $32.34 | $2,187.33 | $2,469.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.16 / $2,603.75 / $3,150.33
| Professional | | $2,045.16 | $2,603.75 | $3,150.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.01 / $2,468.61 / $3,491.32
| Professional | | $1,740.01 | $2,468.61 | $3,491.32 |