- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.75 / $1,189.34 / $3,075.67
| Professional | | $984.75 | $1,189.34 | $3,075.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.07 / $1,348.07 / $1,751.81
| Professional | | $1,348.07 | $1,348.07 | $1,751.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.71 / $1,540.81 / $3,037.31
| Professional | | $1,071.71 | $1,540.81 | $3,037.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.46 / $1,623.21 / $2,626.67
| Professional | | $1,220.46 | $1,623.21 | $2,626.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.09 / $1,447.44 / $2,847.43
| Professional | | $1,030.09 | $1,447.44 | $2,847.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.60 / $1,403.53 / $1,732.23
| Professional | | $1,091.60 | $1,403.53 | $1,732.23 |