- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.40 / $928.06 / $1,121.86
| Professional | | $717.40 | $928.06 | $1,121.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.87 / $1,167.13 / $1,644.31
| Professional | | $901.87 | $1,167.13 | $1,644.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.54 / $1,334.26 / $1,891.00
| Professional | | $878.54 | $1,334.26 | $1,891.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.36 / $1,241.89 / $1,905.12
| Professional | | $1,073.36 | $1,241.89 | $1,905.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.40 / $1,024.91 / $1,121.86
| Professional | | $717.40 | $1,024.91 | $1,121.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.75 / $1,183.82 / $1,723.19
| Professional | | $850.75 | $1,183.82 | $1,723.19 |