- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,096.48
| Professional | | $512.86 | $645.65 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,047.13
| Professional | | $457.09 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,122.02 / $1,445.44
| Professional | | $645.65 | $1,122.02 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $4,265.80
| Professional | | $870.96 | $1,174.90 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,659.59
| Professional | | $1,000.00 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $1,412.54
| Professional | | $851.14 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,513.56
| Professional | | $831.76 | $1,122.02 | $1,513.56 |