- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.65 / $985.62 / $1,609.83
| Professional | | $909.65 | $985.62 | $1,609.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.72 / $1,189.39 / $1,486.74
| Professional | | $1,040.72 | $1,189.39 | $1,486.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.13 / $1,277.76 / $2,082.06
| Professional | | $936.13 | $1,277.76 | $2,082.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.32 / $1,182.59 / $9,057.00
| Professional | | $943.32 | $1,182.59 | $9,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.10 / $1,103.76 / $2,091.59
| Professional | | $927.10 | $1,103.76 | $2,091.59 |