- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.26 / $739.57 / $1,307.61
| Professional | | $566.26 | $739.57 | $1,307.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.46 / $746.00 / $1,140.33
| Professional | | $603.46 | $746.00 | $1,140.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.34 / $947.21 / $1,645.52
| Professional | | $640.34 | $947.21 | $1,645.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.66 / $1,105.09 / $10,000.00
| Professional | | $762.66 | $1,105.09 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.08 / $1,040.36 / $1,760.40
| Professional | | $746.08 | $1,040.36 | $1,760.40 |