- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.12 / $795.66 / $806.21
| Professional | | $577.12 | $795.66 | $806.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.61 / $1,210.15 / $2,413.58
| Professional | | $1,026.61 | $1,210.15 | $2,413.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.69 / $1,151.42 / $1,503.10
| Professional | | $738.69 | $1,151.42 | $1,503.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.35 / $997.75 / $1,503.10
| Professional | | $696.35 | $997.75 | $1,503.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.72 / $944.08 / $2,744.50
| Professional | | $837.72 | $944.08 | $2,744.50 |