- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.15 / $728.18 / $1,132.32
| Professional | | $593.15 | $728.18 | $1,132.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.87 / $1,021.33 / $2,240.42
| Professional | | $641.87 | $1,021.33 | $2,240.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.46 / $981.53 / $1,234.50
| Professional | | $735.46 | $981.53 | $1,234.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.72 / $905.66 / $1,771.55
| Professional | | $545.72 | $905.66 | $1,771.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.54 / $868.41 / $2,361.91
| Professional | | $611.54 | $868.41 | $2,361.91 |