- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.52 / $712.21 / $1,343.30
| Professional | | $549.52 | $712.21 | $1,343.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.36 / $899.18 / $1,050.84
| Professional | | $701.36 | $899.18 | $1,050.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.28 / $859.77 / $1,461.86
| Professional | | $600.28 | $859.77 | $1,461.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.24 / $872.86 / $10,000.00
| Professional | | $692.24 | $872.86 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.49 / $816.42 / $1,559.79
| Professional | | $675.49 | $816.42 | $1,559.79 |