- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,300.77 / $2,382.64
| Professional | | $1,019.68 | $1,300.77 | $2,382.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.47 / $2,144.25 / $2,670.00
| Professional | | $1,303.47 | $2,144.25 | $2,670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.70 / $1,745.55 / $2,767.02
| Professional | | $1,182.70 | $1,745.55 | $2,767.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.73 / $2,035.12 / $3,643.71
| Professional | | $1,397.73 | $2,035.12 | $3,643.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,343.12 / $1,397.73 / $1,799.73
| Professional | | $1,343.12 | $1,397.73 | $1,799.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $2,035.08
| Professional | | $32.34 | $32.34 | $2,035.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.84 / $1,805.73 / $3,192.37
| Professional | | $1,326.84 | $1,805.73 | $3,192.37 |