- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $682.19 / $836.12
| Professional | | $593.14 | $682.19 | $836.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.40 / $820.73 / $1,033.77
| Professional | | $610.40 | $820.73 | $1,033.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.59 / $843.95 / $1,141.29
| Professional | | $617.59 | $843.95 | $1,141.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.55 / $841.25 / $5,774.16
| Professional | | $650.55 | $841.25 | $5,774.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.95 / $787.52 / $1,186.56
| Professional | | $640.95 | $787.52 | $1,186.56 |