- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.20 / $1,087.66 / $1,228.38
| Professional | | $976.20 | $1,087.66 | $1,228.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.67 / $1,353.23 / $2,085.92
| Professional | | $1,045.67 | $1,353.23 | $2,085.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.99 / $1,598.38 / $2,253.79
| Professional | | $1,140.99 | $1,598.38 | $2,253.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.03 / $1,518.02 / $2,328.71
| Professional | | $1,312.03 | $1,518.02 | $2,328.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.96 / $1,228.38 / $1,640.03
| Professional | | $1,043.96 | $1,228.38 | $1,640.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.00 / $1,413.30 / $2,080.66
| Professional | | $1,006.00 | $1,413.30 | $2,080.66 |