- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.15 / $1,721.10 / $2,024.31
| Professional | | $1,010.15 | $1,721.10 | $2,024.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.61 / $1,597.58 / $1,926.49
| Professional | | $1,170.61 | $1,597.58 | $1,926.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,572.86 / $1,715.85 / $2,310.48
| Professional | | $1,572.86 | $1,715.85 | $2,310.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,379.45 / $1,735.44
| Professional | | $32.34 | $1,379.45 | $1,735.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.92 / $1,932.85 / $2,310.48
| Professional | | $1,642.92 | $1,932.85 | $2,310.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.95 / $1,744.76 / $2,657.52
| Professional | | $1,250.95 | $1,744.76 | $2,657.52 |