- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.51 / $1,003.77 / $1,361.99
| Professional | | $839.51 | $1,003.77 | $1,361.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.07 / $1,261.76 / $1,992.49
| Professional | | $987.07 | $1,261.76 | $1,992.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.48 / $1,391.73 / $2,386.48
| Professional | | $1,019.48 | $1,391.73 | $2,386.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.69 / $1,492.97 / $9,057.00
| Professional | | $1,045.69 | $1,492.97 | $9,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.66 / $1,369.01 / $2,274.98
| Professional | | $990.66 | $1,369.01 | $2,274.98 |