- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.25 / $985.62 / $1,153.25
| Professional | | $876.25 | $985.62 | $1,153.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.87 / $891.50 / $1,388.95
| Professional | | $260.87 | $891.50 | $1,388.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.52 / $1,282.58 / $1,832.26
| Professional | | $895.52 | $1,282.58 | $1,832.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.61 / $1,422.44 / $2,169.85
| Professional | | $968.61 | $1,422.44 | $2,169.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,190.97
| Professional | | $32.34 | $32.34 | $1,190.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.66 / $1,308.14 / $2,118.36
| Professional | | $990.66 | $1,308.14 | $2,118.36 |