- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $8,128.31
| Professional | | $776.25 | $1,513.56 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $954.99 / $1,258.93
| Professional | | $933.25 | $954.99 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,047.13 / $2,041.74
| Professional | | $1,023.29 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,737.80
| Professional | | $1,698.24 | $1,698.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $8,912.51
| Professional | | $1,258.93 | $1,905.46 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $2,290.87
| Professional | | $1,230.27 | $1,862.09 | $2,290.87 |