- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.30 / $811.71 / $1,035.02
| Professional | | $750.30 | $811.71 | $1,035.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.63 / $1,115.05 / $1,584.82
| Professional | | $861.63 | $1,115.05 | $1,584.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.51 / $1,242.03 / $1,772.69
| Professional | | $845.51 | $1,242.03 | $1,772.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.03 / $1,197.53 / $1,837.07
| Professional | | $1,035.03 | $1,197.53 | $1,837.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.62 / $947.10 / $1,541.10
| Professional | | $689.62 | $947.10 | $1,541.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.48 / $1,113.34 / $1,643.77
| Professional | | $786.48 | $1,113.34 | $1,643.77 |