- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.49 / $919.54 / $1,329.06
| Professional | | $597.49 | $919.54 | $1,329.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.08 / $1,134.17 / $1,472.15
| Professional | | $743.08 | $1,134.17 | $1,472.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $788.80 / $1,314.67
| Professional | | $32.34 | $788.80 | $1,314.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.08 / $1,160.03 / $1,578.65
| Professional | | $743.08 | $1,160.03 | $1,578.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.85 / $1,283.80 / $1,933.91
| Professional | | $896.85 | $1,283.80 | $1,933.91 |