- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.04 / $625.54 / $985.67
| Professional | | $593.04 | $625.54 | $985.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.52 / $918.52 / $3,026.55
| Professional | | $918.52 | $918.52 | $3,026.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.74 / $1,009.09 / $1,937.12
| Professional | | $671.74 | $1,009.09 | $1,937.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.03 / $1,010.82 / $1,937.12
| Professional | | $702.03 | $1,010.82 | $1,937.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.12 / $1,172.42 / $3,536.95
| Professional | | $823.12 | $1,172.42 | $3,536.95 |