- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.47 / $1,105.14 / $1,768.74
| Professional | | $944.47 | $1,105.14 | $1,768.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.43 / $1,497.85 / $2,132.03
| Professional | | $1,157.43 | $1,497.85 | $2,132.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.76 / $1,665.89 / $2,382.59
| Professional | | $1,138.76 | $1,665.89 | $2,382.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.41 / $1,611.02 / $2,471.39
| Professional | | $1,392.41 | $1,611.02 | $2,471.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.47 / $1,141.08 / $1,768.74
| Professional | | $944.47 | $1,141.08 | $1,768.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.01 / $1,491.90 / $2,212.92
| Professional | | $944.01 | $1,491.90 | $2,212.92 |