- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.72 / $657.29 / $1,301.63
| Professional | | $422.72 | $657.29 | $1,301.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.04 / $1,087.97 / $2,012.65
| Professional | | $682.04 | $1,087.97 | $2,012.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.95 / $1,344.61 / $2,545.13
| Professional | | $726.95 | $1,344.61 | $2,545.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.33 / $1,286.95 / $2,392.21
| Professional | | $748.33 | $1,286.95 | $2,392.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.14 / $1,067.96 / $3,604.00
| Professional | | $604.14 | $1,067.96 | $3,604.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.14 / $1,008.63 / $2,369.44
| Professional | | $604.14 | $1,008.63 | $2,369.44 |