- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.94 / $845.84 / $1,447.66
| Professional | | $650.94 | $845.84 | $1,447.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.54 / $1,615.50 / $2,299.10
| Professional | | $654.54 | $1,615.50 | $2,299.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.10 / $1,466.70 / $2,811.69
| Professional | | $936.10 | $1,466.70 | $2,811.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.99 / $1,195.08 / $2,202.63
| Professional | | $1,038.99 | $1,195.08 | $2,202.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.59 / $915.94 / $2,473.04
| Professional | | $336.59 | $915.94 | $2,473.04 |