- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.82 / $823.28 / $2,149.82
| Professional | | $755.82 | $823.28 | $2,149.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.29 / $848.42 / $1,060.00
| Professional | | $820.29 | $848.42 | $1,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.09 / $957.02 / $2,200.56
| Professional | | $674.09 | $957.02 | $2,200.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.23 / $968.55 / $1,588.01
| Professional | | $728.23 | $968.55 | $1,588.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.64 / $967.65 / $1,643.38
| Professional | | $635.64 | $967.65 | $1,643.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.22 / $837.46 / $1,041.10
| Professional | | $593.22 | $837.46 | $1,041.10 |