- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.58 / $1,274.76 / $3,258.97
| Professional | | $460.58 | $1,274.76 | $3,258.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.39 / $756.83 / $2,728.36
| Professional | | $558.39 | $756.83 | $2,728.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.96 / $1,477.02 / $2,637.54
| Professional | | $576.96 | $1,477.02 | $2,637.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $2,107.30 / $2,348.13
| Professional | | $32.34 | $2,107.30 | $2,348.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.33 / $665.38 / $2,631.66
| Professional | | $548.33 | $665.38 | $2,631.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.91 / $2,999.14 / $4,138.14
| Professional | | $1,684.91 | $2,999.14 | $4,138.14 |