- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.77 / $1,086.83 / $6,270.76
| Professional | | $1,082.77 | $1,086.83 | $6,270.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.60 / $1,021.71 / $1,255.02
| Professional | | $985.60 | $1,021.71 | $1,255.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.17 / $1,052.24 / $2,009.26
| Professional | | $299.17 | $1,052.24 | $2,009.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $1,286.00 / $1,875.42
| Professional | | $2.11 | $1,286.00 | $1,875.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $1,030.36 / $1,607.51
| Professional | | $2.11 | $1,030.36 | $1,607.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.06 / $1,287.83 / $2,014.98
| Professional | | $497.06 | $1,287.83 | $2,014.98 |