- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.63 / $528.77 / $3,218.08
| Professional | | $521.63 | $528.77 | $3,218.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.03 / $694.64 / $793.05
| Professional | | $677.03 | $694.64 | $793.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.70 / $811.58 / $1,601.14
| Professional | | $567.70 | $811.58 | $1,601.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.50 / $857.19 / $1,387.42
| Professional | | $644.50 | $857.19 | $1,387.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.52 / $729.61 / $1,244.54
| Professional | | $530.52 | $729.61 | $1,244.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.41 / $741.18 / $914.44
| Professional | | $576.41 | $741.18 | $914.44 |