- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.63 / $1,030.27 / $2,782.77
| Professional | | $938.63 | $1,030.27 | $2,782.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.40 / $1,113.83 / $1,255.64
| Professional | | $998.40 | $1,113.83 | $1,255.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.77 / $1,448.38 / $2,609.08
| Professional | | $946.77 | $1,448.38 | $2,609.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.61 / $1,335.95 / $2,195.73
| Professional | | $1,035.61 | $1,335.95 | $2,195.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.67 / $1,239.91 / $2,073.82
| Professional | | $847.67 | $1,239.91 | $2,073.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.61 / $1,190.96 / $1,481.28
| Professional | | $1,035.61 | $1,190.96 | $1,481.28 |