- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.52 / $944.07 / $4,092.22
| Professional | | $776.52 | $944.07 | $4,092.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.05 / $948.28 / $1,213.80
| Professional | | $931.05 | $948.28 | $1,213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.79 / $1,120.02 / $2,053.08
| Professional | | $763.79 | $1,120.02 | $2,053.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.50 / $1,112.55 / $1,786.44
| Professional | | $836.50 | $1,112.55 | $1,786.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.48 / $964.59 / $1,744.66
| Professional | | $704.48 | $964.59 | $1,744.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.97 / $961.97 / $1,174.43
| Professional | | $642.97 | $961.97 | $1,174.43 |