- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $796.29 / $1,669.03
| Professional | | $593.14 | $796.29 | $1,669.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.21 / $1,162.96 / $1,606.86
| Professional | | $632.21 | $1,162.96 | $1,606.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.31 / $1,235.58 / $1,910.75
| Professional | | $823.31 | $1,235.58 | $1,910.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.48 / $951.99 / $1,396.71
| Professional | | $660.48 | $951.99 | $1,396.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.58 / $1,264.88 / $2,226.98
| Professional | | $686.58 | $1,264.88 | $2,226.98 |