- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.66 / $920.75 / $1,795.46
| Professional | | $781.66 | $920.75 | $1,795.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.16 / $408.16 / $654.40
| Professional | | $408.16 | $408.16 | $654.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.60 / $1,268.33 / $1,268.33
| Professional | | $900.60 | $1,268.33 | $1,268.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.27 / $962.42 / $1,476.40
| Professional | | $747.27 | $962.42 | $1,476.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.75 / $920.75 / $1,795.46
| Professional | | $920.75 | $920.75 | $1,795.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.82 / $1,056.10 / $1,374.67
| Professional | | $831.82 | $1,056.10 | $1,374.67 |