- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.11 / $571.66 / $2,493.78
| Professional | | $474.11 | $571.66 | $2,493.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.64 / $1,101.73 / $2,077.78
| Professional | | $934.64 | $1,101.73 | $2,077.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.31 / $784.19 / $1,001.13
| Professional | | $482.31 | $784.19 | $1,001.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.31 / $782.64 / $1,001.13
| Professional | | $482.31 | $782.64 | $1,001.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.64 / $703.32 / $2,347.23
| Professional | | $574.64 | $703.32 | $2,347.23 |