- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $732.66 / $820.93
| Professional | | $593.14 | $732.66 | $820.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.83 / $1,558.36 / $1,932.24
| Professional | | $1,234.83 | $1,558.36 | $1,932.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.35 / $1,617.95 / $2,434.65
| Professional | | $787.35 | $1,617.95 | $2,434.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.19 / $1,449.33 / $4,686.47
| Professional | | $801.19 | $1,449.33 | $4,686.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.19 / $1,396.28 / $1,705.14
| Professional | | $801.19 | $1,396.28 | $1,705.14 |