- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.48 / $639.55 / $2,960.21
| Professional | | $536.48 | $639.55 | $2,960.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.16 / $996.25 / $2,004.67
| Professional | | $845.16 | $996.25 | $2,004.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.80 / $866.93 / $1,029.83
| Professional | | $512.80 | $866.93 | $1,029.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.80 / $821.89 / $1,029.83
| Professional | | $512.80 | $821.89 | $1,029.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.29 / $658.62 / $2,303.08
| Professional | | $613.29 | $658.62 | $2,303.08 |