- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.68 / $1,204.96 / $1,442.42
| Professional | | $1,019.68 | $1,204.96 | $1,442.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.66 / $1,194.70 / $1,669.29
| Professional | | $1,014.66 | $1,194.70 | $1,669.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.36 / $1,446.28 / $2,324.39
| Professional | | $1,136.36 | $1,446.28 | $2,324.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.27 / $1,786.09 / $2,763.31
| Professional | | $1,232.27 | $1,786.09 | $2,763.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $695.83 / $1,344.50
| Professional | | $32.34 | $695.83 | $1,344.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.75 / $1,802.68 / $2,802.01
| Professional | | $1,304.75 | $1,802.68 | $2,802.01 |