- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.24 / $1,039.98 / $5,167.75
| Professional | | $998.24 | $1,039.98 | $5,167.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.56 / $1,176.54 / $1,344.78
| Professional | | $1,133.56 | $1,176.54 | $1,344.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.42 / $1,350.58 / $3,051.59
| Professional | | $971.42 | $1,350.58 | $3,051.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.47 / $1,342.60 / $2,146.25
| Professional | | $1,009.47 | $1,342.60 | $2,146.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.19 / $1,145.76 / $1,972.34
| Professional | | $838.19 | $1,145.76 | $1,972.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.75 / $1,160.89 / $1,443.84
| Professional | | $820.75 | $1,160.89 | $1,443.84 |