- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.14 / $677.72 / $845.45
| Professional | | $593.14 | $677.72 | $845.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.80 / $730.33 / $7,812.00
| Professional | | $682.80 | $730.33 | $7,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.95 / $1,018.24 / $2,302.62
| Professional | | $633.95 | $1,018.24 | $2,302.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.48 / $1,821.79 / $1,821.79
| Professional | | $1,464.48 | $1,821.79 | $1,821.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.00 / $1,054.93 / $2,205.69
| Professional | | $592.00 | $1,054.93 | $2,205.69 |