- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.28 / $1,424.91 / $1,858.04
| Professional | | $1,078.28 | $1,424.91 | $1,858.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.45 / $1,103.13 / $2,121.40
| Professional | | $322.45 | $1,103.13 | $2,121.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.42 / $1,620.57 / $2,526.46
| Professional | | $1,038.42 | $1,620.57 | $2,526.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.20 / $1,621.97 / $2,320.62
| Professional | | $1,419.20 | $1,621.97 | $2,320.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.00 / $991.42 / $1,665.09
| Professional | | $137.00 | $991.42 | $1,665.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.16 / $1,901.82 / $2,635.84
| Professional | | $1,557.16 | $1,901.82 | $2,635.84 |