- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.31 / $848.80 / $1,057.65
| Professional | | $726.31 | $848.80 | $1,057.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.29 / $827.40 / $1,171.64
| Professional | | $703.29 | $827.40 | $1,171.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.66 / $1,031.74 / $1,658.16
| Professional | | $810.66 | $1,031.74 | $1,658.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.10 / $1,270.77 / $2,010.22
| Professional | | $845.10 | $1,270.77 | $2,010.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $435.09 / $984.46
| Professional | | $32.34 | $435.09 | $984.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.53 / $1,258.69 / $2,032.60
| Professional | | $912.53 | $1,258.69 | $2,032.60 |