- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.97 / $1,011.50 / $1,139.35
| Professional | | $962.97 | $1,011.50 | $1,139.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.75 / $2,182.21 / $2,558.78
| Professional | | $1,983.75 | $2,182.21 | $2,558.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.81 / $2,486.96 / $3,312.65
| Professional | | $1,244.81 | $2,486.96 | $3,312.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.73 / $2,072.71 / $2,802.70
| Professional | | $1,100.73 | $2,072.71 | $2,802.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.73 / $1,957.57 / $2,421.61
| Professional | | $1,100.73 | $1,957.57 | $2,421.61 |