- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.09 / $634.94 / $918.41
| Professional | | $545.09 | $634.94 | $918.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.81 / $1,399.17 / $1,803.05
| Professional | | $718.81 | $1,399.17 | $1,803.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.27 / $1,093.58 / $1,300.65
| Professional | | $1,032.27 | $1,093.58 | $1,300.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.05 / $1,024.13 / $1,069.41
| Professional | | $1,022.05 | $1,024.13 | $1,069.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.25 / $1,382.72 / $4,283.07
| Professional | | $731.25 | $1,382.72 | $4,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.71 / $1,372.75 / $2,445.36
| Professional | | $684.71 | $1,372.75 | $2,445.36 |