- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.26 / $712.21 / $1,007.02
| Professional | | $566.26 | $712.21 | $1,007.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.92 / $745.08 / $1,028.21
| Professional | | $463.92 | $745.08 | $1,028.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.34 / $809.04 / $1,071.51
| Professional | | $714.34 | $809.04 | $1,071.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.77 / $813.41 / $1,327.88
| Professional | | $598.77 | $813.41 | $1,327.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.28 / $857.21 / $1,589.37
| Professional | | $664.28 | $857.21 | $1,589.37 |