- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.06 / $1,137.39 / $1,152.77
| Professional | | $999.06 | $1,137.39 | $1,152.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,229.61 / $1,414.06 / $1,612.03
| Professional | | $1,229.61 | $1,414.06 | $1,612.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.62 / $814.62 / $814.62
| Professional | | $814.62 | $814.62 | $814.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,767.57 / $2,305.53
| Professional | | $1,537.02 | $1,767.57 | $2,305.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $691.66 / $1,228.91
| Professional | | $645.54 | $691.66 | $1,228.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.51 / $768.51 / $768.51
| Professional | | $768.51 | $768.51 | $768.51 |