- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.17 / $1,101.54 / $3,427.00
| Professional | | $1,050.17 | $1,101.54 | $3,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,188.88 / $1,247.33 / $1,425.70
| Professional | | $1,188.88 | $1,247.33 | $1,425.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.50 / $1,388.49 / $3,227.30
| Professional | | $969.50 | $1,388.49 | $3,227.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.14 / $1,406.00 / $2,269.51
| Professional | | $1,057.14 | $1,406.00 | $2,269.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.89 / $1,273.01 / $2,373.40
| Professional | | $921.89 | $1,273.01 | $2,373.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.30 / $1,215.71 / $1,500.69
| Professional | | $840.30 | $1,215.71 | $1,500.69 |