- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.70 / $776.67 / $1,307.44
| Professional | | $580.70 | $776.67 | $1,307.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.22 / $1,352.47 / $10,000.00
| Professional | | $681.22 | $1,352.47 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.61 / $1,563.76 / $1,794.56
| Professional | | $1,185.61 | $1,563.76 | $1,794.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.41 / $1,249.35 / $2,264.98
| Professional | | $744.41 | $1,249.35 | $2,264.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.53 / $1,108.52 / $1,530.20
| Professional | | $911.53 | $1,108.52 | $1,530.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.79 / $1,620.48 / $2,278.82
| Professional | | $765.79 | $1,620.48 | $2,278.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.98 / $1,483.69 / $10,000.00
| Professional | | $828.98 | $1,483.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.43 / $1,299.43 / $3,144.79
| Professional | | $816.43 | $1,299.43 | $3,144.79 |