- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.08 / $703.71 / $4,332.60
| Professional | | $692.08 | $703.71 | $4,332.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.86 / $925.88 / $1,036.54
| Professional | | $906.86 | $925.88 | $1,036.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.45 / $1,104.25 / $2,140.06
| Professional | | $771.45 | $1,104.25 | $2,140.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.03 / $1,157.14 / $1,850.49
| Professional | | $870.03 | $1,157.14 | $1,850.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.51 / $990.02 / $1,668.36
| Professional | | $725.51 | $990.02 | $1,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.47 / $1,000.53 / $1,234.98
| Professional | | $805.47 | $1,000.53 | $1,234.98 |