- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.38 / $694.86 / $978.00
| Professional | | $570.38 | $694.86 | $978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.24 / $568.40 / $807.12
| Professional | | $448.24 | $568.40 | $807.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.11 / $835.33 / $1,044.17
| Professional | | $696.11 | $835.33 | $1,044.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.04 / $781.93 / $1,305.81
| Professional | | $533.04 | $781.93 | $1,305.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.91 / $802.05 / $1,418.11
| Professional | | $616.91 | $802.05 | $1,418.11 |