- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.52 / $735.67 / $3,371.46
| Professional | | $595.52 | $735.67 | $3,371.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.29 / $1,068.39 / $1,470.65
| Professional | | $617.29 | $1,068.39 | $1,470.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.28 / $1,681.94 / $2,247.69
| Professional | | $945.28 | $1,681.94 | $2,247.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.70 / $1,601.71 / $4,686.47
| Professional | | $955.70 | $1,601.71 | $4,686.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.82 / $1,552.60 / $2,123.35
| Professional | | $1,165.82 | $1,552.60 | $2,123.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.70 / $1,632.03 / $1,939.33
| Professional | | $955.70 | $1,632.03 | $1,939.33 |