- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.32 / $1,024.99 / $1,156.19
| Professional | | $878.32 | $1,024.99 | $1,156.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.15 / $1,151.57 / $1,720.31
| Professional | | $691.15 | $1,151.57 | $1,720.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.59 / $1,241.38 / $1,895.05
| Professional | | $745.59 | $1,241.38 | $1,895.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.41 / $1,247.34 / $6,966.43
| Professional | | $647.41 | $1,247.34 | $6,966.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.90 / $1,198.09 / $2,178.36
| Professional | | $632.90 | $1,198.09 | $2,178.36 |