- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.67 / $1,032.03 / $1,328.48
| Professional | | $962.67 | $1,032.03 | $1,328.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.32 / $1,278.13 / $1,483.29
| Professional | | $1,150.32 | $1,278.13 | $1,483.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.31 / $1,328.29 / $2,924.73
| Professional | | $800.31 | $1,328.29 | $2,924.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.20 / $1,343.51 / $2,263.65
| Professional | | $1,050.20 | $1,343.51 | $2,263.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.15 / $1,058.66 / $1,929.15
| Professional | | $626.15 | $1,058.66 | $1,929.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.10 / $1,256.98 / $1,587.78
| Professional | | $825.10 | $1,256.98 | $1,587.78 |