- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.41 / $796.01 / $1,218.53
| Professional | | $688.41 | $796.01 | $1,218.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.85 / $1,027.33 / $1,465.53
| Professional | | $793.85 | $1,027.33 | $1,465.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.78 / $1,142.47 / $1,635.07
| Professional | | $783.78 | $1,142.47 | $1,635.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.13 / $1,107.40 / $1,698.81
| Professional | | $957.13 | $1,107.40 | $1,698.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.86 / $757.26 / $952.06
| Professional | | $631.86 | $757.26 | $952.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.40 / $1,009.39 / $1,521.27
| Professional | | $647.40 | $1,009.39 | $1,521.27 |