- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.29 / $980.15 / $1,560.74
| Professional | | $819.29 | $980.15 | $1,560.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.64 / $1,344.70 / $1,969.22
| Professional | | $1,050.64 | $1,344.70 | $1,969.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.37 / $1,454.52 / $2,414.12
| Professional | | $993.37 | $1,454.52 | $2,414.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.30 / $1,587.07 / $10,915.46
| Professional | | $1,115.30 | $1,587.07 | $10,915.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.26 / $1,456.12 / $2,346.92
| Professional | | $1,069.26 | $1,456.12 | $2,346.92 |