- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.20 / $707.17 / $1,192.47
| Professional | | $574.20 | $707.17 | $1,192.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.71 / $701.58 / $1,112.85
| Professional | | $552.71 | $701.58 | $1,112.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.72 / $910.42 / $1,515.30
| Professional | | $639.72 | $910.42 | $1,515.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.09 / $1,147.25 / $5,774.16
| Professional | | $737.09 | $1,147.25 | $5,774.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.04 / $927.72 / $1,639.92
| Professional | | $697.04 | $927.72 | $1,639.92 |