- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.97 / $580.27 / $2,443.98
| Professional | | $463.97 | $580.27 | $2,443.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.74 / $994.58 / $2,128.89
| Professional | | $843.74 | $994.58 | $2,128.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.78 / $787.27 / $1,022.01
| Professional | | $494.78 | $787.27 | $1,022.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.78 / $772.00 / $1,022.01
| Professional | | $494.78 | $772.00 | $1,022.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.42 / $803.75 / $2,393.63
| Professional | | $689.42 | $803.75 | $2,393.63 |