- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.15 / $511.55 / $2,044.99
| Professional | | $405.15 | $511.55 | $2,044.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.02 / $730.74 / $2,037.87
| Professional | | $419.02 | $730.74 | $2,037.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.50 / $1,287.53 / $2,920.80
| Professional | | $429.50 | $1,287.53 | $2,920.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.63 / $738.20 / $1,990.34
| Professional | | $373.63 | $738.20 | $1,990.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.15 / $511.55 / $2,044.99
| Professional | | $405.15 | $511.55 | $2,044.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,575.91 / $2,120.58 / $2,543.39
| Professional | | $1,575.91 | $2,120.58 | $2,543.39 |