- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.12 / $897.89 / $1,132.34
| Professional | | $618.12 | $897.89 | $1,132.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.75 / $951.47 / $1,268.45
| Professional | | $808.75 | $951.47 | $1,268.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.41 / $1,358.82 / $2,083.76
| Professional | | $802.41 | $1,358.82 | $2,083.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.83 / $1,170.73 / $2,069.00
| Professional | | $953.83 | $1,170.73 | $2,069.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.12 / $809.54 / $1,132.34
| Professional | | $618.12 | $809.54 | $1,132.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.58 / $1,000.80 / $1,931.52
| Professional | | $721.58 | $1,000.80 | $1,931.52 |