- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $2,454.71
| Professional | | $1,122.02 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $2,041.74
| Professional | | $1,202.26 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,479.11 / $1,862.09
| Professional | | $1,023.29 | $1,479.11 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $9,772.37
| Professional | | $1,513.56 | $2,344.23 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,445.44
| Professional | | $32.36 | $33.11 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,951.21
| Professional | | $1,258.93 | $1,862.09 | $2,951.21 |