- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.59 / $1,210.76 / $1,464.65
| Professional | | $1,163.59 | $1,210.76 | $1,464.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.25 / $1,634.65 / $2,529.31
| Professional | | $953.25 | $1,634.65 | $2,529.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.92 / $1,883.21 / $3,241.69
| Professional | | $1,286.92 | $1,883.21 | $3,241.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.27 / $1,790.34 / $3,368.20
| Professional | | $1,091.27 | $1,790.34 | $3,368.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.47 / $1,695.88 / $3,345.07
| Professional | | $1,247.47 | $1,695.88 | $3,345.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.41 / $1,000.35 / $1,273.17
| Professional | | $909.41 | $1,000.35 | $1,273.17 |