- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.70 / $1,270.51 / $1,459.22
| Professional | | $982.70 | $1,270.51 | $1,459.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.38 / $1,581.91 / $2,252.58
| Professional | | $1,222.38 | $1,581.91 | $2,252.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,210.92 / $1,753.33 / $2,595.89
| Professional | | $1,210.92 | $1,753.33 | $2,595.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.14 / $1,702.11 / $2,611.13
| Professional | | $1,471.14 | $1,702.11 | $2,611.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.70 / $1,316.65 / $1,459.22
| Professional | | $982.70 | $1,316.65 | $1,459.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.54 / $1,565.33 / $2,371.17
| Professional | | $1,079.54 | $1,565.33 | $2,371.17 |