- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.02 / $984.45 / $1,182.11
| Professional | | $785.02 | $984.45 | $1,182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.17 / $1,274.93 / $1,810.13
| Professional | | $985.17 | $1,274.93 | $1,810.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.25 / $1,418.55 / $2,026.36
| Professional | | $965.25 | $1,418.55 | $2,026.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.19 / $1,367.79 / $2,098.27
| Professional | | $1,182.19 | $1,367.79 | $2,098.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.02 / $1,083.35 / $1,182.11
| Professional | | $785.02 | $1,083.35 | $1,182.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.92 / $1,258.05 / $1,839.49
| Professional | | $817.92 | $1,258.05 | $1,839.49 |