- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.60 / $470.35 / $2,165.51
| Professional | | $454.60 | $470.35 | $2,165.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.20 / $880.02 / $2,558.16
| Professional | | $489.20 | $880.02 | $2,558.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.72 / $1,308.07 / $3,284.88
| Professional | | $567.72 | $1,308.07 | $3,284.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.60 / $1,309.17 / $3,027.98
| Professional | | $567.60 | $1,309.17 | $3,027.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.60 / $470.35 / $2,165.51
| Professional | | $454.60 | $470.35 | $2,165.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.87 / $2,611.73 / $3,381.10
| Professional | | $2,044.87 | $2,611.73 | $3,381.10 |