- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.64 / $1,139.72 / $1,373.70
| Professional | | $998.64 | $1,139.72 | $1,373.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.30 / $1,479.57 / $2,095.42
| Professional | | $1,143.30 | $1,479.57 | $2,095.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.57 / $1,648.44 / $2,349.07
| Professional | | $1,115.57 | $1,648.44 | $2,349.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.50 / $1,583.35 / $2,428.94
| Professional | | $1,368.50 | $1,583.35 | $2,428.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.64 / $1,221.70 / $1,723.95
| Professional | | $998.64 | $1,221.70 | $1,723.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.30 / $1,517.14 / $2,172.44
| Professional | | $1,046.30 | $1,517.14 | $2,172.44 |