- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.80 / $1,286.49 / $1,777.12
| Professional | | $1,050.80 | $1,286.49 | $1,777.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.59 / $1,621.40 / $2,745.84
| Professional | | $1,006.59 | $1,621.40 | $2,745.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.30 / $1,230.15 / $1,546.23
| Professional | | $644.30 | $1,230.15 | $1,546.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.24 / $976.18 / $1,702.39
| Professional | | $144.24 | $976.18 | $1,702.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.56 / $1,473.36 / $2,583.83
| Professional | | $1,072.56 | $1,473.36 | $2,583.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.70 / $1,031.00 / $1,031.00
| Professional | | $860.70 | $1,031.00 | $1,031.00 |