- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.21 / $1,007.71 / $2,326.44
| Professional | | $934.21 | $1,007.71 | $2,326.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.82 / $1,080.92 / $1,235.48
| Professional | | $967.82 | $1,080.92 | $1,235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.62 / $1,021.97 / $2,079.56
| Professional | | $769.62 | $1,021.97 | $2,079.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.35 / $1,082.76 / $1,788.45
| Professional | | $839.35 | $1,082.76 | $1,788.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.54 / $951.29 / $1,595.28
| Professional | | $697.54 | $951.29 | $1,595.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.97 / $670.97 / $1,179.72
| Professional | | $670.97 | $670.97 | $1,179.72 |