- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.34 / $1,084.41 / $1,637.61
| Professional | | $967.34 | $1,084.41 | $1,637.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.43 / $1,367.15 / $2,081.98
| Professional | | $1,056.43 | $1,367.15 | $2,081.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.27 / $1,597.01 / $2,266.19
| Professional | | $1,147.27 | $1,597.01 | $2,266.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.56 / $1,515.16 / $2,324.34
| Professional | | $1,309.56 | $1,515.16 | $2,324.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.25 / $1,235.01 / $1,945.47
| Professional | | $902.25 | $1,235.01 | $1,945.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.44 / $1,394.76 / $2,086.63
| Professional | | $1,011.44 | $1,394.76 | $2,086.63 |