- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.64 / $739.60 / $950.16
| Professional | | $528.64 | $739.60 | $950.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.06 / $990.24 / $2,525.00
| Professional | | $840.06 | $990.24 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.38 / $1,034.33 / $1,664.45
| Professional | | $645.38 | $1,034.33 | $1,664.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.01 / $1,087.77 / $1,664.45
| Professional | | $786.01 | $1,087.77 | $1,664.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.74 / $1,045.42 / $3,039.12
| Professional | | $858.74 | $1,045.42 | $3,039.12 |