- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.41 / $1,329.26 / $6,267.23
| Professional | | $1,047.41 | $1,329.26 | $6,267.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.25 / $1,503.30 / $1,982.45
| Professional | | $1,243.25 | $1,503.30 | $1,982.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,726.51 / $2,508.00
| Professional | | $1,151.00 | $1,726.51 | $2,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.31 / $1,382.07 / $2,273.15
| Professional | | $31.31 | $1,382.07 | $2,273.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $1,164.05 / $2,228.58
| Professional | | $21.30 | $1,164.05 | $2,228.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,346.07 / $1,775.60 / $2,671.90
| Professional | | $1,346.07 | $1,775.60 | $2,671.90 |