- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.71 / $936.14 / $2,002.38
| Professional | | $831.71 | $936.14 | $2,002.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.50 / $1,037.49 / $1,185.84
| Professional | | $966.50 | $1,037.49 | $1,185.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.82 / $1,176.65 / $2,051.19
| Professional | | $766.82 | $1,176.65 | $2,051.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.52 / $1,103.26 / $1,772.55
| Professional | | $829.52 | $1,103.26 | $1,772.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.67 / $949.42 / $1,626.46
| Professional | | $703.67 | $949.42 | $1,626.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.60 / $953.95 / $1,164.38
| Professional | | $645.60 | $953.95 | $1,164.38 |