- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.61 / $406.58 / $542.00
| Professional | | $286.61 | $406.58 | $542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.37 / $565.02 / $1,664.84
| Professional | | $465.37 | $565.02 | $1,664.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.30 / $562.74 / $1,427.76
| Professional | | $350.30 | $562.74 | $1,427.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.18 / $581.78 / $1,427.76
| Professional | | $356.18 | $581.78 | $1,427.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.47 / $571.29 / $1,660.80
| Professional | | $428.47 | $571.29 | $1,660.80 |