- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.76 / $753.17 / $1,001.20
| Professional | | $604.76 | $753.17 | $1,001.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.17 / $1,012.06 / $1,417.68
| Professional | | $618.17 | $1,012.06 | $1,417.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.87 / $1,353.20 / $2,227.28
| Professional | | $859.87 | $1,353.20 | $2,227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.85 / $1,256.51 / $2,402.19
| Professional | | $747.85 | $1,256.51 | $2,402.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.09 / $1,277.33 / $2,159.89
| Professional | | $824.09 | $1,277.33 | $2,159.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.89 / $625.36 / $750.43
| Professional | | $501.89 | $625.36 | $750.43 |