- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.25 / $764.89 / $3,575.44
| Professional | | $571.25 | $764.89 | $3,575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.28 / $813.69 / $1,092.19
| Professional | | $723.28 | $813.69 | $1,092.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.79 / $920.15 / $1,548.64
| Professional | | $641.79 | $920.15 | $1,548.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.76 / $1,126.08 / $6,882.96
| Professional | | $725.76 | $1,126.08 | $6,882.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.55 / $943.21 / $1,792.37
| Professional | | $697.55 | $943.21 | $1,792.37 |