- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.36 / $900.80 / $2,298.69
| Professional | | $728.36 | $900.80 | $2,298.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.83 / $1,171.90 / $1,333.04
| Professional | | $927.83 | $1,171.90 | $1,333.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.90 / $1,124.73 / $1,913.71
| Professional | | $789.90 | $1,124.73 | $1,913.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.85 / $1,218.10 / $10,316.10
| Professional | | $909.85 | $1,218.10 | $10,316.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.50 / $1,059.20 / $2,018.52
| Professional | | $880.50 | $1,059.20 | $2,018.52 |