- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.02 / $1,471.48 / $2,485.62
| Professional | | $752.02 | $1,471.48 | $2,485.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.71 / $1,738.52 / $2,661.06
| Professional | | $1,387.71 | $1,738.52 | $2,661.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.99 / $1,940.51 / $2,845.28
| Professional | | $1,444.99 | $1,940.51 | $2,845.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.15 / $1,988.73 / $3,050.82
| Professional | | $1,544.15 | $1,988.73 | $3,050.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.01 / $1,471.48 / $2,485.62
| Professional | | $1,162.01 | $1,471.48 | $2,485.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,268.83 / $1,861.88 / $2,683.66
| Professional | | $1,268.83 | $1,861.88 | $2,683.66 |