- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.67 / $1,147.99 / $1,838.88
| Professional | | $979.67 | $1,147.99 | $1,838.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.22 / $2,704.25 / $3,427.71
| Professional | | $1,694.22 | $2,704.25 | $3,427.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,796.73 / $2,862.15 / $4,250.72
| Professional | | $1,796.73 | $2,862.15 | $4,250.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.70 / $2,558.94 / $3,898.17
| Professional | | $1,626.70 | $2,558.94 | $3,898.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.59 / $2,294.16 / $4,669.39
| Professional | | $1,264.59 | $2,294.16 | $4,669.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.47 / $2,329.81 / $4,361.63
| Professional | | $1,247.47 | $2,329.81 | $4,361.63 |