- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.16 / $1,505.28 / $1,519.39
| Professional | | $982.16 | $1,505.28 | $1,519.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.53 / $1,264.30 / $1,934.76
| Professional | | $1,009.53 | $1,264.30 | $1,934.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.47 / $1,505.28 / $2,111.65
| Professional | | $1,228.47 | $1,505.28 | $2,111.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.24 / $1,206.92 / $1,877.97
| Professional | | $1,084.24 | $1,206.92 | $1,877.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.38 / $1,505.27 / $1,814.76
| Professional | | $1,080.38 | $1,505.27 | $1,814.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.94 / $2,142.16 / $6,442.86
| Professional | | $1,180.94 | $2,142.16 | $6,442.86 |