- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.80 / $1,267.15 / $6,175.75
| Professional | | $1,050.80 | $1,267.15 | $6,175.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.39 / $1,455.53 / $1,893.55
| Professional | | $1,251.39 | $1,455.53 | $1,893.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.25 / $1,663.15 / $2,371.71
| Professional | | $1,039.25 | $1,663.15 | $2,371.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.88 / $1,531.57 / $3,001.38
| Professional | | $15.88 | $1,531.57 | $3,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $1,297.07 / $4,739.03
| Professional | | $10.80 | $1,297.07 | $4,739.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.44 / $1,668.95 / $2,530.78
| Professional | | $1,285.44 | $1,668.95 | $2,530.78 |