- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.02 / $1,177.43 / $2,195.67
| Professional | | $1,078.02 | $1,177.43 | $2,195.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.00 / $1,131.73 / $1,369.39
| Professional | | $980.00 | $1,131.73 | $1,369.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.97 / $1,274.06 / $2,424.35
| Professional | | $901.97 | $1,274.06 | $2,424.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.88 / $1,275.66 / $2,096.03
| Professional | | $988.88 | $1,275.66 | $2,096.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.01 / $1,181.96 / $1,976.07
| Professional | | $845.01 | $1,181.96 | $1,976.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.77 / $915.77 / $1,385.72
| Professional | | $915.77 | $915.77 | $1,385.72 |