- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.66 / $832.74 / $1,027.58
| Professional | | $810.66 | $832.74 | $1,027.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.18 / $1,066.45 / $1,322.13
| Professional | | $904.18 | $1,066.45 | $1,322.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.48 / $1,167.40 / $1,622.81
| Professional | | $844.48 | $1,167.40 | $1,622.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.35 / $1,195.94 / $10,316.10
| Professional | | $900.35 | $1,195.94 | $10,316.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.38 / $1,112.19 / $1,493.51
| Professional | | $847.38 | $1,112.19 | $1,493.51 |