- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.01 / $765.57 / $3,246.76
| Professional | | $579.01 | $765.57 | $3,246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.70 / $1,063.47 / $1,508.38
| Professional | | $598.70 | $1,063.47 | $1,508.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.71 / $1,547.86 / $2,287.63
| Professional | | $1,012.71 | $1,547.86 | $2,287.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.16 / $1,637.57 / $2,271.98
| Professional | | $990.16 | $1,637.57 | $2,271.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.17 / $1,615.74 / $2,142.89
| Professional | | $1,183.17 | $1,615.74 | $2,142.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.16 / $1,637.57 / $2,009.26
| Professional | | $990.16 | $1,637.57 | $2,009.26 |