- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.62 / $1,048.41 / $1,610.28
| Professional | | $985.62 | $1,048.41 | $1,610.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,736.10 / $2,773.59 / $3,629.64
| Professional | | $1,736.10 | $2,773.59 | $3,629.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,843.65 / $2,936.89 / $4,361.72
| Professional | | $1,843.65 | $2,936.89 | $4,361.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.18 / $2,625.78 / $3,999.96
| Professional | | $1,669.18 | $2,625.78 | $3,999.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.80 / $2,158.53 / $4,321.39
| Professional | | $1,210.80 | $2,158.53 | $4,321.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.75 / $2,139.63 / $4,125.92
| Professional | | $1,133.75 | $2,139.63 | $4,125.92 |