- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.41 / $1,441.31 / $3,022.62
| Professional | | $1,137.41 | $1,441.31 | $3,022.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.72 / $1,980.43 / $2,709.41
| Professional | | $1,293.72 | $1,980.43 | $2,709.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $244.19 / $2,034.94
| Professional | | $32.34 | $244.19 | $2,034.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,398.19 / $2,069.94 / $2,966.42
| Professional | | $1,398.19 | $2,069.94 | $2,966.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.07 / $2,205.32 / $3,435.20
| Professional | | $1,651.07 | $2,205.32 | $3,435.20 |