- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,047.13
| Professional | | $660.69 | $912.01 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $1,659.59
| Professional | | $954.99 | $1,288.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,412.54
| Professional | | $776.25 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $6,309.57
| Professional | | $831.76 | $1,096.48 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $1,621.81
| Professional | | $794.33 | $1,071.52 | $1,621.81 |