- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.41 / $1,868.08 / $6,267.23
| Professional | | $1,047.41 | $1,868.08 | $6,267.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.47 / $1,908.18 / $2,661.18
| Professional | | $1,348.47 | $1,908.18 | $2,661.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.95 / $862.61 / $1,368.80
| Professional | | $122.95 | $862.61 | $1,368.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.68 / $2,158.61 / $4,045.50
| Professional | | $1,465.68 | $2,158.61 | $4,045.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.29 / $1,611.57 / $2,537.01
| Professional | | $1,272.29 | $1,611.57 | $2,537.01 |