- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.41 / $588.16 / $1,163.08
| Professional | | $528.41 | $588.16 | $1,163.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.86 / $581.86 / $895.00
| Professional | | $570.86 | $581.86 | $895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.27 / $586.92 / $1,209.75
| Professional | | $450.27 | $586.92 | $1,209.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.45 / $635.26 / $1,040.10
| Professional | | $492.45 | $635.26 | $1,040.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.41 / $587.36 / $1,052.47
| Professional | | $422.41 | $587.36 | $1,052.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.09 / $404.09 / $690.62
| Professional | | $404.09 | $404.09 | $690.62 |