- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.39 / $908.45 / $931.10
| Professional | | $666.39 | $908.45 | $931.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.69 / $1,067.69 / $2,762.21
| Professional | | $1,067.69 | $1,067.69 | $2,762.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.60 / $1,325.64 / $1,722.82
| Professional | | $838.60 | $1,325.64 | $1,722.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.79 / $1,140.33 / $1,722.82
| Professional | | $797.79 | $1,140.33 | $1,722.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.37 / $1,082.07 / $3,145.67
| Professional | | $993.37 | $1,082.07 | $3,145.67 |