- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.47 / $997.92 / $1,335.05
| Professional | | $902.47 | $997.92 | $1,335.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.91 / $1,076.69 / $1,590.00
| Professional | | $1,058.91 | $1,076.69 | $1,590.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.08 / $1,397.36 / $2,531.51
| Professional | | $923.08 | $1,397.36 | $2,531.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.71 / $1,302.53 / $1,707.23
| Professional | | $1,009.71 | $1,302.53 | $1,707.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.49 / $1,248.21 / $2,288.42
| Professional | | $868.49 | $1,248.21 | $2,288.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.71 / $1,161.17 / $1,446.56
| Professional | | $1,009.71 | $1,161.17 | $1,446.56 |