- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.00 / $1,693.72 / $2,440.98
| Professional | | $1,323.00 | $1,693.72 | $2,440.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.31 / $1,308.59 / $1,865.09
| Professional | | $1,112.31 | $1,308.59 | $1,865.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.91 / $1,132.95 / $1,374.30
| Professional | | $832.91 | $1,132.95 | $1,374.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.70 / $2,565.21 / $5,992.28
| Professional | | $1,686.70 | $2,565.21 | $5,992.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $916.20
| Professional | | $32.34 | $32.34 | $916.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.32 / $1,396.51 / $1,896.63
| Professional | | $1,041.32 | $1,396.51 | $1,896.63 |