- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.62 / $1,186.13 / $1,356.27
| Professional | | $985.62 | $1,186.13 | $1,356.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.89 / $1,673.47 / $2,494.46
| Professional | | $975.89 | $1,673.47 | $2,494.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.86 / $1,881.02 / $3,021.42
| Professional | | $1,325.86 | $1,881.02 | $3,021.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.20 / $1,832.88 / $3,448.24
| Professional | | $1,117.20 | $1,832.88 | $3,448.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.64 / $1,579.40 / $3,192.92
| Professional | | $1,141.64 | $1,579.40 | $3,192.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.71 / $1,010.05 / $1,594.20
| Professional | | $841.71 | $1,010.05 | $1,594.20 |