- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.19 / $671.34 / $673.24
| Professional | | $481.19 | $671.34 | $673.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.24 / $1,001.07 / $2,051.01
| Professional | | $849.24 | $1,001.07 | $2,051.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.79 / $955.55 / $1,267.23
| Professional | | $623.79 | $955.55 | $1,267.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.24 / $840.41 / $1,267.23
| Professional | | $596.24 | $840.41 | $1,267.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.42 / $795.93 / $2,313.82
| Professional | | $683.42 | $795.93 | $2,313.82 |