- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.53 / $970.48 / $1,415.26
| Professional | | $674.53 | $970.48 | $1,415.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.52 / $626.52 / $626.52
| Professional | | $626.52 | $626.52 | $626.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.37 / $1,000.46 / $1,000.46
| Professional | | $800.37 | $1,000.46 | $1,000.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.45 / $1,044.93 / $2,350.66
| Professional | | $733.45 | $1,044.93 | $2,350.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.90 / $848.52 / $5,712.10
| Professional | | $368.90 | $848.52 | $5,712.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.35 / $830.52 / $1,203.80
| Professional | | $387.35 | $830.52 | $1,203.80 |