- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.74 / $1,094.23 / $1,244.17
| Professional | | $830.74 | $1,094.23 | $1,244.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.90 / $1,339.28 / $1,907.33
| Professional | | $1,034.90 | $1,339.28 | $1,907.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.73 / $1,493.01 / $2,224.11
| Professional | | $1,031.73 | $1,493.01 | $2,224.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.67 / $1,441.24 / $2,210.94
| Professional | | $1,245.67 | $1,441.24 | $2,210.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.74 / $1,122.23 / $1,244.17
| Professional | | $830.74 | $1,122.23 | $1,244.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.76 / $1,274.41 / $2,025.37
| Professional | | $887.76 | $1,274.41 | $2,025.37 |