- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.34 / $1,123.66 / $1,228.07
| Professional | | $985.34 | $1,123.66 | $1,228.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.18 / $1,413.41 / $2,146.86
| Professional | | $1,092.18 | $1,413.41 | $2,146.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.42 / $1,632.64 / $2,280.31
| Professional | | $1,154.42 | $1,632.64 | $2,280.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.37 / $1,562.38 / $2,396.77
| Professional | | $1,350.37 | $1,562.38 | $2,396.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.38 / $1,228.07 / $1,664.01
| Professional | | $1,070.38 | $1,228.07 | $1,664.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.02 / $1,533.03 / $2,120.71
| Professional | | $1,022.02 | $1,533.03 | $2,120.71 |