- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.44 / $1,061.05 / $1,410.57
| Professional | | $918.44 | $1,061.05 | $1,410.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.58 / $1,372.96 / $2,358.55
| Professional | | $818.58 | $1,372.96 | $2,358.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.87 / $952.22 / $1,166.08
| Professional | | $541.87 | $952.22 | $1,166.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.12 / $726.19 / $1,257.70
| Professional | | $107.12 | $726.19 | $1,257.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.31 / $1,177.52 / $2,154.86
| Professional | | $829.31 | $1,177.52 | $2,154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.44 / $752.44 / $952.22
| Professional | | $752.44 | $752.44 | $952.22 |