- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.13 / $910.23 / $5,584.17
| Professional | | $894.13 | $910.23 | $5,584.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.54 / $1,290.05 / $1,474.52
| Professional | | $1,253.54 | $1,290.05 | $1,474.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.81 / $1,425.03 / $2,758.16
| Professional | | $983.81 | $1,425.03 | $2,758.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.97 / $1,466.25 / $2,384.89
| Professional | | $1,109.97 | $1,466.25 | $2,384.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.96 / $1,284.28 / $2,164.23
| Professional | | $925.96 | $1,284.28 | $2,164.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.54 / $1,276.47 / $1,575.38
| Professional | | $1,010.54 | $1,276.47 | $1,575.38 |