- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.91 / $739.55 / $745.14
| Professional | | $533.91 | $739.55 | $745.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.90 / $1,099.68 / $2,244.89
| Professional | | $932.90 | $1,099.68 | $2,244.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.04 / $1,070.05 / $1,398.45
| Professional | | $684.04 | $1,070.05 | $1,398.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.98 / $928.06 / $1,398.45
| Professional | | $646.98 | $928.06 | $1,398.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.73 / $878.35 / $2,553.41
| Professional | | $763.73 | $878.35 | $2,553.41 |