- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.32 / $1,025.17 / $1,966.14
| Professional | | $985.32 | $1,025.17 | $1,966.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.57 / $1,060.29 / $1,217.00
| Professional | | $1,059.57 | $1,060.29 | $1,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.12 / $1,296.19 / $3,007.24
| Professional | | $967.12 | $1,296.19 | $3,007.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.34 / $1,322.47 / $2,116.53
| Professional | | $994.34 | $1,322.47 | $2,116.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.13 / $1,190.26 / $1,952.08
| Professional | | $847.13 | $1,190.26 | $1,952.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.13 / $1,143.49 / $1,422.59
| Professional | | $778.13 | $1,143.49 | $1,422.59 |