- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.27 / $980.15 / $1,560.74
| Professional | | $889.27 | $980.15 | $1,560.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.69 / $1,756.11 / $1,756.11
| Professional | | $1,492.69 | $1,756.11 | $1,756.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.27 / $1,437.29 / $2,351.61
| Professional | | $1,085.27 | $1,437.29 | $2,351.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.32 / $1,440.55 / $10,915.46
| Professional | | $1,169.32 | $1,440.55 | $10,915.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.43 / $1,338.15 / $1,935.12
| Professional | | $1,152.43 | $1,338.15 | $1,935.12 |