- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.67 / $1,485.36 / $2,297.62
| Professional | | $930.67 | $1,485.36 | $2,297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.49 / $1,589.89 / $2,355.21
| Professional | | $1,292.49 | $1,589.89 | $2,355.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,237.73 / $1,732.12 / $2,743.61
| Professional | | $1,237.73 | $1,732.12 | $2,743.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.44 / $1,756.00 / $2,693.80
| Professional | | $1,363.44 | $1,756.00 | $2,693.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.35 / $1,485.36 / $2,297.62
| Professional | | $1,485.35 | $1,485.36 | $2,297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.56 / $1,692.92 / $2,488.00
| Professional | | $1,187.56 | $1,692.92 | $2,488.00 |