- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.22 / $789.58 / $1,253.47
| Professional | | $640.22 | $789.58 | $1,253.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.24 / $841.46 / $1,048.74
| Professional | | $715.24 | $841.46 | $1,048.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.84 / $917.77 / $1,544.62
| Professional | | $666.84 | $917.77 | $1,544.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.78 / $993.79 / $5,774.16
| Professional | | $747.78 | $993.79 | $5,774.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.63 / $894.82 / $1,260.52
| Professional | | $732.63 | $894.82 | $1,260.52 |