- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.02 / $838.02 / $892.47
| Professional | | $838.02 | $838.02 | $892.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.06 / $1,103.14 / $1,593.45
| Professional | | $920.06 | $1,103.14 | $1,593.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.08 / $1,191.58 / $1,806.28
| Professional | | $986.08 | $1,191.58 | $1,806.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.53 / $1,202.31 / $1,844.41
| Professional | | $933.53 | $1,202.31 | $1,844.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.02 / $838.02 / $892.47
| Professional | | $838.02 | $838.02 | $892.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.53 / $1,300.67 / $1,657.54
| Professional | | $933.53 | $1,300.67 | $1,657.54 |