- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.58 / $824.39 / $1,307.61
| Professional | | $625.58 | $824.39 | $1,307.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.93 / $850.51 / $1,095.71
| Professional | | $722.93 | $850.51 | $1,095.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.00 / $945.38 / $1,612.73
| Professional | | $662.00 | $945.38 | $1,612.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.11 / $977.30 / $10,000.00
| Professional | | $804.11 | $977.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.74 / $928.28 / $1,317.30
| Professional | | $789.74 | $928.28 | $1,317.30 |