- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.85 / $723.92 / $1,215.56
| Professional | | $566.85 | $723.92 | $1,215.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.45 / $1,092.03 / $2,578.92
| Professional | | $593.45 | $1,092.03 | $2,578.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.62 / $1,256.81 / $1,541.70
| Professional | | $957.62 | $1,256.81 | $1,541.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.59 / $969.16 / $1,507.17
| Professional | | $549.59 | $969.16 | $1,507.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.17 / $933.16 / $2,204.21
| Professional | | $553.17 | $933.16 | $2,204.21 |