- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.77 / $917.36 / $4,379.81
| Professional | | $739.77 | $917.36 | $4,379.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.94 / $1,356.47 / $1,867.20
| Professional | | $781.94 | $1,356.47 | $1,867.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,428.79 / $1,960.93 / $2,845.66
| Professional | | $1,428.79 | $1,960.93 | $2,845.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.58 / $2,158.50 / $10,173.00
| Professional | | $1,272.58 | $2,158.50 | $10,173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.09 / $2,114.94 / $2,698.43
| Professional | | $1,550.09 | $2,114.94 | $2,698.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.58 / $2,104.66 / $2,740.95
| Professional | | $1,272.58 | $2,104.66 | $2,740.95 |