- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.93 / $1,320.07 / $2,036.58
| Professional | | $998.93 | $1,320.07 | $2,036.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.04 / $1,367.59 / $1,792.42
| Professional | | $1,024.04 | $1,367.59 | $1,792.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.39 / $1,585.67 / $1,922.02
| Professional | | $1,288.39 | $1,585.67 | $1,922.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,383.07 / $1,561.53
| Professional | | $32.34 | $1,383.07 | $1,561.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.93 / $1,666.71 / $2,119.21
| Professional | | $1,344.93 | $1,666.71 | $2,119.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.30 / $1,571.43 / $2,222.46
| Professional | | $1,115.30 | $1,571.43 | $2,222.46 |