- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.70 / $829.97 / $1,818.02
| Professional | | $580.70 | $829.97 | $1,818.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.02 / $1,227.45 / $1,713.27
| Professional | | $636.02 | $1,227.45 | $1,713.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.04 / $1,225.77 / $1,917.81
| Professional | | $882.04 | $1,225.77 | $1,917.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.94 / $1,099.31 / $1,539.83
| Professional | | $674.94 | $1,099.31 | $1,539.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.74 / $1,302.71 / $2,343.33
| Professional | | $718.74 | $1,302.71 | $2,343.33 |