- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.73 / $934.98 / $1,750.17
| Professional | | $762.73 | $934.98 | $1,750.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.63 / $955.07 / $1,484.01
| Professional | | $706.63 | $955.07 | $1,484.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.09 / $1,008.84 / $1,283.98
| Professional | | $948.09 | $1,008.84 | $1,283.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.85 / $1,238.13 / $1,801.62
| Professional | | $841.85 | $1,238.13 | $1,801.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.68 / $1,242.45 / $1,801.62
| Professional | | $861.68 | $1,242.45 | $1,801.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.98 / $689.21 / $1,162.73
| Professional | | $107.98 | $689.21 | $1,162.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.42 / $1,238.13 / $2,003.15
| Professional | | $794.42 | $1,238.13 | $2,003.15 |