- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.43 / $759.21 / $1,395.20
| Professional | | $506.43 | $759.21 | $1,395.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.25 / $1,050.64 / $1,577.34
| Professional | | $813.25 | $1,050.64 | $1,577.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.69 / $1,280.18 / $2,140.79
| Professional | | $859.69 | $1,280.18 | $2,140.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.57 / $1,279.88 / $1,991.49
| Professional | | $985.57 | $1,279.88 | $1,991.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.37 / $944.14 / $1,426.26
| Professional | | $686.37 | $944.14 | $1,426.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.71 / $1,239.01 / $2,029.37
| Professional | | $865.71 | $1,239.01 | $2,029.37 |