- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.94 / $790.22 / $1,482.04
| Professional | | $650.94 | $790.22 | $1,482.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.07 / $601.07 / $678.63
| Professional | | $601.07 | $601.07 | $678.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.19 / $745.47 / $879.65
| Professional | | $544.19 | $745.47 | $879.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.61 / $951.56 / $2,724.40
| Professional | | $737.61 | $951.56 | $2,724.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.23 / $594.00 / $877.25
| Professional | | $384.23 | $594.00 | $877.25 |