- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.16 / $770.63 / $1,307.44
| Professional | | $560.16 | $770.63 | $1,307.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.37 / $1,201.71 / $1,537.96
| Professional | | $700.37 | $1,201.71 | $1,537.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.62 / $937.91 / $1,499.52
| Professional | | $603.62 | $937.91 | $1,499.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.17 / $1,129.43 / $3,223.54
| Professional | | $726.17 | $1,129.43 | $3,223.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.10 / $744.22 / $1,046.44
| Professional | | $727.10 | $744.22 | $1,046.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,207.43
| Professional | | $32.34 | $32.34 | $1,207.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.20 / $1,019.50 / $1,826.75
| Professional | | $745.20 | $1,019.50 | $1,826.75 |