- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.08 / $1,187.16 / $1,325.03
| Professional | | $1,101.08 | $1,187.16 | $1,325.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.41 / $1,260.91 / $1,601.36
| Professional | | $1,144.41 | $1,260.91 | $1,601.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.75 / $1,205.08 / $2,457.42
| Professional | | $909.75 | $1,205.08 | $2,457.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.38 / $1,280.17 / $2,114.76
| Professional | | $992.38 | $1,280.17 | $2,114.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.81 / $1,110.05 / $2,006.42
| Professional | | $861.81 | $1,110.05 | $2,006.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.35 / $853.35 / $1,394.64
| Professional | | $853.35 | $853.35 | $1,394.64 |