- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.38 / $753.17 / $1,253.85
| Professional | | $570.38 | $753.17 | $1,253.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.33 / $948.12 / $1,464.79
| Professional | | $655.33 | $948.12 | $1,464.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.12 / $951.10 / $1,503.81
| Professional | | $676.12 | $951.10 | $1,503.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,535.76 / $5,568.88 / $6,458.63
| Professional | | $4,535.76 | $5,568.88 | $6,458.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.12 / $843.56 / $1,705.46
| Professional | | $664.12 | $843.56 | $1,705.46 |