- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.46 / $711.66 / $1,495.18
| Professional | | $572.46 | $711.66 | $1,495.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.55 / $967.12 / $2,963.61
| Professional | | $796.55 | $967.12 | $2,963.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.08 / $861.92 / $2,026.15
| Professional | | $615.08 | $861.92 | $2,026.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.11 / $1,030.74 / $2,026.15
| Professional | | $739.11 | $1,030.74 | $2,026.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.11 / $985.47 / $3,133.04
| Professional | | $739.11 | $985.47 | $3,133.04 |