- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.13 / $732.66 / $1,277.25
| Professional | | $565.13 | $732.66 | $1,277.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.62 / $912.40 / $1,037.85
| Professional | | $722.62 | $912.40 | $1,037.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.66 / $823.54 / $1,400.32
| Professional | | $576.66 | $823.54 | $1,400.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.79 / $865.80 / $5,774.16
| Professional | | $643.79 | $865.80 | $5,774.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.41 / $761.13 / $1,466.18
| Professional | | $633.41 | $761.13 | $1,466.18 |