- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $2,290.87
| Professional | | $724.44 | $891.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,148.15 / $1,584.89
| Professional | | $676.08 | $1,148.15 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $1,659.59
| Professional | | $891.25 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,479.11
| Professional | | $831.76 | $1,023.29 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $2,398.83
| Professional | | $741.31 | $1,023.29 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,621.81
| Professional | | $758.58 | $1,071.52 | $1,621.81 |