- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,548.82
| Professional | | $575.44 | $794.33 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,230.27
| Professional | | $707.95 | $1,000.00 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,412.54
| Professional | | $575.44 | $912.01 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,122.02 / $2,951.21
| Professional | | $616.60 | $1,122.02 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,023.29
| Professional | | $758.58 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $794.33
| Professional | | $32.36 | $33.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,380.38
| Professional | | $588.84 | $812.83 | $1,380.38 |