- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.03 / $609.26 / $3,725.29
| Professional | | $600.03 | $609.26 | $3,725.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.36 / $907.06 / $1,161.04
| Professional | | $816.36 | $907.06 | $1,161.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.75 / $982.07 / $1,847.11
| Professional | | $641.75 | $982.07 | $1,847.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.03 / $958.51 / $1,600.43
| Professional | | $743.03 | $958.51 | $1,600.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.67 / $837.80 / $1,442.20
| Professional | | $615.67 | $837.80 | $1,442.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.32 / $854.48 / $1,054.43
| Professional | | $653.32 | $854.48 | $1,054.43 |